| Date of birth: | 1943 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 174551 |
| SO#: | 122771 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9401407 |
| Booking date: | Jan 21, 1994 |
| Release date: | Jan 21, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 932004075 |
| Amount: | $110 |