| Date of birth: | 1914 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 405965 |
| SO#: | 204663 |
| Booked at: | SALT LAKE |
| Cob: | Michigan |
| Booking number: | 9514391 |
| Booking date: | Jul 6, 1995 |
| Release date: | Jul 18, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 951009593 |
| Amount: | $270 |