| Date of birth: | 1930 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| SO#: | 204279 |
| Booked at: | SALT LAKE |
| Cob: | District of Columbia |
| Booking number: | 9513086 |
| Booking date: | Jun 17, 1995 |
| Release date: | Jun 17, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 951002119MS |