| Date of birth: | 1940 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 145725 |
| SO#: | 80183 |
| Booked at: | SALT LAKE |
| Cob: | District of Columbia |
| Booking number: | 9504301 |
| Booking date: | Feb 25, 1995 |
| Release date: | Feb 25, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 921003755 |
| Amount: | $500 |