| Date of birth: | 1938 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 169878 |
| SO#: | 98964 |
| Booked at: | SALT LAKE |
| Cob: | Georgia |
| Booking number: | 9511261 |
| Booking date: | May 23, 1995 |
| Release date: | May 25, 1995 |
| Booking location: | Salt Lake County, UT |
| Amount: | $50 |
| Number: | D642-207 |
| Amount: | $170 |