| Date of birth: | 1945 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| SO#: | 215248 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9621530 |
| Booking date: | Nov 1, 1996 |
| Release date: | Nov 1, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961020200 |
| Amount: | $2,500 |