| Date of birth: | 1930 |
| Hair: | Brown |
| Eyes: | Green |
| State id: | 309312 |
| SO#: | 193067 |
| Booked at: | SALT LAKE |
| Cob: | South Dakota |
| Booking number: | 9400118 |
| Booking date: | Jan 3, 1994 |
| Release date: | Jan 3, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 911010631FS |
| Amount: | $1,500 |