| Date of birth: | 1944 |
| Hair: | Brown |
| Eyes: | Hazel |
| State id: | 100827 |
| SO#: | 48451 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0420571 |
| Booking date: | Aug 27, 2004 |
| Release date: | Sep 7, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 021300532 |
| Amount: | $382 |
| Number: | 04TR01053 |
| Amount: | $1,500 |