DOJ-OGR-00029028.tif

FD-S15 (Rev, 12-19-06) @ Accomplishment Report ° Date Prepared OV2F DX” Squad supervisor approval {Accomplishment musi be reported and loaded into Date Loaded / ao 05” {please inilial) ISRAA within 30 days from date of accomplishment) Date Loader’s Initiats ry — investigative Assistance or Technique Used Accomplishment involves: (check ali that apply) File Number 4. Used, but dic aot help 3, Helped, substantially a | Sler-jHA7-/OS OG. 2. Helped, minimally 4. Absolutely essential For Sub, Invest. Assist. by alher FO(s) indicate A, 8, C, D for camesponding FO a Stat Agent Soc. Sec, No. b6 -2 Bankruptcy Fraud. Cb Rate FO AT Rate EO IAP Rate FO TAT Rate FO IAT bic 2 Computer FraudiAbuse == BIE -6 Gorruption of Public Official a Pan Registers E - Money Laundering Computer Photo Cover F Sub Invest Asst by FO(s) < conf Intl Ass SARs Asst. FO(s) ELSUR /FISC Crisis Nep.- Local A BC. D. Fort Support Pel Eng, Field Spt Sd naar Evid. Purchase Ft, Mon, - TC USO - Group I Non FBI Lab Ex | A. Complaint f Information/ Indictment J. Civil Rico Matters Date: 0 Federal Cilocal [7] internationat a rau ati Also complete “Section G" Complaint Date: ate! Other Civil Matters Date: Check if Civil Rico Gomplaint. udgment Judicial Outcome we information Date: Amount $ Indictment Date: Suspension: Years Months Plea (1) Tria B. Locate Arrest. Stale: EL. Judicial District i, Administrative Sanction Date: C1 Federal Bileca (J International ; Subject Description Code ; _ G. U.S. Code Violation Type: Length: Subject Prosity 1A OB Ke Required for sections A, B, F and J : Suspension (1 Permanent Losate Date: (Federal Only) A Debarment or Arrest Date: OG a Title Section injunction Year Months. {] Subject Resisted Arrest ———— —_— _ L. Asset Seizure Date: £7] Subject Arresied was Anned Asset Forfeiture Date: CATS # Mandatery... ¢, Summons Date: Circle below one of lhe three asset forfeiture: C]Federat Loca! Admin, Civil Judisiat, or Criminal ————— rt eT Do not indicate $ vatue in Section B D. Recovery / Restitution / PELP X H. Sent Dat [federal FJiéca! [J international + Sentence Vater M, Acquittal! Dismissai/ Pretrial Diversion Recovery Date: Senlence Type: ‘ : we . : . éCircte one) Date: Code vy Amount $ in Jail: Years_______ Months. Code"_ ev) Amount $ Suspended: ‘Years__.. Months___ N. Drug Selzures “Date: Restitution Bates CiCourt Ordered 1] Pretrial Diversion Probation: = Years_____ Months____ Drug Gode * > Code # “Amount $ Fines: $e Weight ———_____. Gede PELP Date: FDIN BS ee . Go net incicate $ in Section D Code * ¥ Amount $2 1, Disruption/Dismantiement: v E, Hestages(s) Released Date:___ . . GO. Child Victhn information Disruption Dates Retaased by: (J Terrorist (_] Other Child tocaled/identified Date: Dismanttement Date; 0 Number of Hostages; Livin: B Completion of FD-5i5a Side 2 Mandatory Citiving D)Deceased P, Subject Information - Required for ali blocks excisding block D (RecoveryiPELP}, blocks &, |, L and N be -1 b7c -1 f | Subject ratsigd to an LOM, Asi POrganced Gene (AOC), italien Crmanized Como HOC}, RussinvGostin Evrepags, Carbbean, or Nigedan Ciganizad Ceima Group - Complite #D-Si5a, Sida 1 Blocks AE mandatory, F-H as appropeaia, . Oo Subject roloted te an OC/Diug onganzabon, a VOM Program National Geng Slratopy target group, of a VOMO Program National Priority tmustws tergel group - Competa FO-5450, Slfe ¢ Blocks A-C anh, x Additional information may be added by attaching another form or @ plain sheet of paper for additional entries. Serial No. of FD « See codes on reverse side. po ¥ Requires that an explanation be attached and loaded into ISRAA jor recovery over $1 m and PELP over $5 m, disruption, dismanlement, and drug seizures. 3/E- Hh ~ (Obi nM | a _ DOJ-OGR- 00029028