| Date of birth: | 1939 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 0151956 |
| SO#: | 164168 |
| Booked at: | SALT LAKE |
| Cob: | Minnesota |
| Booking number: | 9522390 |
| Booking date: | Oct 21, 1995 |
| Release date: | Oct 29, 1995 |
| Booking location: | Salt Lake County, UT |
| Amount: | $250 |
| Number: | 941000840 |
| Amount: | $505 |