| Date of birth: | 1927 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 103260 |
| SO#: | 51733 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9319815 |
| Booking date: | Nov 10, 1993 |
| Release date: | Nov 10, 1993 |
| Booking location: | Salt Lake County, UT |
| Number: | 931000014 |
| Amount: | $505 |
| Amount: | $300 |