| Date of birth: | 1936 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 418608 |
| SO#: | 275623 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0325484 |
| Booking date: | Oct 8, 2003 |
| Release date: | Oct 9, 2003 |
| Booking location: | Salt Lake County, UT |
| Amount: | $2,822 |