| Date of birth: | 1944 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 406070 |
| SO#: | 195035 |
| Booked at: | SALT LAKE |
| Cob: | New Jersey |
| Booking number: | 9623217 |
| Booking date: | Nov 22, 1996 |
| Release date: | Nov 26, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 947900222 |
| Number: | 96-1339 |