| Date of birth: | 1922 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 262894 |
| SO#: | 144061 |
| Booked at: | SALT LAKE |
| Cob: | New York |
| Booking number: | 9931065 |
| Booking date: | Dec 18, 1999 |
| Release date: | Dec 19, 1999 |
| Booking location: | Salt Lake County, UT |
| Number: | 981900566 |
| Amount: | $2,500 |