| Date of birth: | 1942 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 129146 |
| SO#: | 69064 |
| Booked at: | SALT LAKE |
| Cob: | Texas |
| Citizen: | UNITED STATES |
| Booking number: | 0414560 |
| Booking date: | Jun 16, 2004 |
| Release date: | Jun 18, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $10,925 |
| Number: | 01-09725 |
| Amount: | $1,760 |
