| Date of birth: | 1929 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 1170987 |
| SO#: | 319008 |
| Booked at: | SALT LAKE |
| Cob: | Kansas |
| Citizen: | UNITED STATES |
| Booking number: | 0930753 |
| Booking date: | Nov 2, 2009 |
| Release date: | Nov 4, 2009 |
| Booking location: | Salt Lake County, UT |
| Number: | 081906702 |