| Date of birth: | 1942 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 1201704 |
| SO#: | 43221 |
| Booked at: | SALT LAKE |
| Cob: | Oregon |
| Citizen: | UNITED STATES |
| Booking number: | 11031223 |
| Booking date: | Jun 19, 2011 |
| Release date: | Jun 21, 2011 |
| Booking location: | Salt Lake County, UT |
| Booking number: | 0928150 |
| Booking date: | Oct 5, 2009 |
| Release date: | Oct 6, 2009 |
| Booking location: | Salt Lake County, UT |
| Offense date: | Jun 19, 2011 |
| Grade: | F |
| Description: | Utter/forge/alter a prescription |
| Degree: | 3 |
| Code: | 58.37.8.3.A.iii |
| Case number: | 031000289 |
| Status: | Open |
| Posted: | Jun 19, 2011 |
| Number: | 031000289 |
| Amount: | $10,000 |
| Number: | 091907451 |
| Amount: | $5,000 |
