| Date of birth: | 1923 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 462949 |
| SO#: | 214971 |
| Booked at: | SALT LAKE |
| Cob: | Texas |
| Booking number: | 9620595 |
| Booking date: | Oct 20, 1996 |
| Release date: | Oct 20, 1996 |
| Booking location: | Salt Lake County, UT |
| Amount: | $500 |