| Date of birth: | 1922 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 463004 |
| SO#: | 215038 |
| Booked at: | SALT LAKE |
| Cob: | Kansas |
| Booking number: | 9620829 |
| Booking date: | Oct 23, 1996 |
| Release date: | Oct 23, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961019121 |
| Amount: | $20,000 |