| Date of birth: | 1939 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 396927 |
| SO#: | 198149 |
| Booked at: | SALT LAKE |
| Cob: | Colorado |
| Booking number: | 9417152 |
| Booking date: | Sep 13, 1994 |
| Release date: | Sep 19, 1994 |
| Booking location: | Salt Lake County, UT |
| Amount: | $150 |
| Number: | 931002929 |
| Amount: | $270 |