| Date of birth: | 1924 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| SO#: | 206459 |
| Booked at: | SALT LAKE |
| Cob: | Idaho |
| Citizen: | UNITED STATES |
| Booking number: | 0418060 |
| Booking date: | Jul 29, 2004 |
| Release date: | Sep 1, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $555 |
| Amount: | $2,432 |
| Number: | 031904241 |
| Amount: | $10,000 |