| Date of birth: | 1929 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 074963 |
| SO#: | 33769 |
| Booked at: | SALT LAKE |
| Cob: | Colorado |
| Booking number: | 0023214 |
| Booking date: | Sep 27, 2000 |
| Release date: | Sep 27, 2000 |
| Booking location: | Salt Lake County, UT |
| Number: | 001900629MO |
| Amount: | $5,000 |