| Date of birth: | 1938 |
| Hair: | Brown |
| Eyes: | Hazel |
| State id: | 169941 |
| SO#: | 134272 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9418325 |
| Booking date: | Sep 28, 1994 |
| Release date: | Oct 12, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 941000645MC |
| Amount: | $500 |