| Date of birth: | 1948 |
| Hair: | Sandy |
| Eyes: | Green |
| State id: | 248216 |
| SO#: | 66199 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0426822 |
| Booking date: | Nov 12, 2004 |
| Release date: | Nov 16, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 041101666 |
| Amount: | $15,000 |