| Date of birth: | 1931 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 463600 |
| SO#: | 215623 |
| Booked at: | SALT LAKE |
| Cob: | Michigan |
| Booking number: | 0122509 |
| Booking date: | Sep 12, 2001 |
| Release date: | Sep 25, 2001 |
| Booking location: | Salt Lake County, UT |
| Number: | 975001103 |
| Amount: | $2,500 |