| Date of birth: | 1955 |
| Hair: | Brown |
| Eyes: | Hazel |
| State id: | 1038474 |
| SO#: | 285970 |
| Booked at: | SALT LAKE |
| Cob: | New York |
| Citizen: | UNITED STATES |
| Booking number: | 0501897 |
| Booking date: | Jan 22, 2005 |
| Release date: | Jan 25, 2005 |
| Booking location: | Salt Lake County, UT |
| Number: | 040005141 |
| Amount: | $3,000 |