| Date of birth: | 1941 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 1036809 |
| SO#: | 275395 |
| Booked at: | SALT LAKE |
| Cob: | Mississippi |
| Citizen: | UNITED STATES |
| Booking number: | 0324625 |
| Booking date: | Sep 29, 2003 |
| Release date: | Oct 1, 2003 |
| Booking location: | Salt Lake County, UT |
| Amount: | $380 |