| Name | William Robert Provine |
|---|---|
| Sex | male |
| Birth Date | December 9, 1937 |
| Death Date | June 28, 1981 |
| Age at Death | 43 years, 6 months, 19 days old |
| Birth Place | California |
| Death Place | Los Angeles County, California |
| Mother's Maiden Name | Youngblood |
| Social Security Number | 562-42-4280 |