| Date of birth: | 1946 |
| Hair: | Brown |
| Eyes: | Green |
| State id: | 0269860 |
| SO#: | 153726 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9623155 |
| Booking date: | Nov 21, 1996 |
| Release date: | Nov 21, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961000682 |
| Amount: | $1,000 |