| Date of birth: | 1945 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 218455 |
| SO#: | 124359 |
| Booked at: | SALT LAKE |
| Cob: | Indiana |
| Booking number: | 9319580 |
| Booking date: | Nov 5, 1993 |
| Release date: | Nov 17, 1993 |
| Booking location: | Salt Lake County, UT |
| Number: | L26622 |
| Amount: | $150 |