| Date of birth: | 1950 |
| Hair: | Blonde |
| Eyes: | Brown |
| State id: | 1050477 |
| SO#: | 279694 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0408508 |
| Booking date: | Apr 5, 2004 |
| Release date: | Apr 5, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $755 |