| Date of birth: | 1946 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 109097 |
| SO#: | 92953 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0409659 |
| Booking date: | Apr 17, 2004 |
| Release date: | Apr 17, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 031905144 |
| Amount: | $5,000 |