| Date of birth: | 1923 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 100299 |
| SO#: | 237751 |
| Booked at: | SALT LAKE |
| Cob: | Nevada |
| Booking number: | 9915134 |
| Booking date: | Jun 20, 1999 |
| Release date: | Jun 20, 1999 |
| Booking location: | Salt Lake County, UT |
| Amount: | $555 |