| Date of birth: | 1946 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| SO#: | 329910 |
| Booked at: | SALT LAKE |
| Cob: | New York |
| Citizen: | UNITED STATES |
| Booking number: | 0928873 |
| Booking date: | Oct 13, 2009 |
| Release date: | Nov 6, 2009 |
| Booking location: | Salt Lake County, UT |
| Number: | 03-4546 |
| Amount: | $100 |