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FD-515 (Rev, 12-19-06) Squad supervisor approval {please inilial) Computer FraudfAbuse Corruption of Public Official Money Laundering Sub Invest Asst by FO(s} Asst. FO(s) A. C.D. B. |_| File Number [3 -(NM -/O8 06 Stat Agent Soc. Sec. No. PE Accomplishment Report {Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment) Date Prepared Date Loaded Date Loader’s Initlats Rate FO investigative Assistance or Technique Used 4. Used, but did aot help 2. Helped, minimally For Sub, Invest. Assist. by olher FO(6) indicate A, 8, C, D for comesponding FO 3, Helped, substantially 4. Absolutely essential GLSUR/FISC ELSUR/T. i b6 -2 tat Rate £0 IAT Rate FO Rete FO AT Fin, Analyst Lab, Fie'6 Sup Viewwiincor | PIC -2 Pen Registers bIE -6 Computer Photo Cov Eng, Field Spt. CART Search Warrant] Asset Forf Prag Show Monay Fort Support Proj SOG Asst, YFOSICTD Tech, AgiEquip, Phone Tali Ree uso tnfraGard/OyD OFCICID InffCW Info Lab. xaM A. Complaint / Information! Indictment O Federal Cilocal Compiaint Date: Check if Civil Rico Complaint (1 Internationat information Date: Indictment Date: B, Locate¢Arrest- Federal toca! [J International Subject Priority: OA OB Ke Locate Date: Arrest Date: £7] Subject Resisted Arrest [7] Subject Arrested was Armed ¢, Summons Date: fFederat [1] Local D. Recovery / Restitution / PELP X [federa) [Jtdcal [] international Recovery Date:. Code * vy Amount $ Code * ¥ Amount $ Restitution Date:, Code*____y Amount $ PELP Date: Code*___y = Amount $ E, Hostages{s) Released Date:. Released by: [J Terrorist ( Other Number of Hostages: Comprete FD-5450, Sido + Blocks A.C only. x Additional information may be added by attaching another form or a plain sheet of paper for additional entries. « See codes on reverse side. [1 Court Ordered =] Pretrial Diversion International For 6F, G, H-include ‘elony or Plea or Bier G. U.S. Code Violation Required for sections A, B, F and J (Federal Only) Title Section Ot f Judicial District: # Counts H, Sentence Date. Sentence Type:. ‘ : in Jail: Years______ Months, Suspended: Years. Months___ Probation: Years. Months__ Fines: $ J. Civil Rico Matters Date: Also complete “Section G" Other Civil Matters Date: Judgment —_- Judicial Outcome Amount $ Suspension: Years Months. K, Administrative Sanction Date;, Subject Description Code ° Type: Length: Suspension (] Permanent Debarment or injunction Year. Months__. L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory Circle beiow one of the three asset forfeiture; Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D M, Acquittal/ Dismissal! Pretrlal Diversion {Circle one) Date: N. Drug Seizures Y Date: Drug Code * Weight FDIN Code * 1, DisruptioniDismantiement Disruption Date: Dismanttement Date; Completion of FD-515a Side 2 Mandatory P, Subject Information - Required for all biocks excisding block D (Recoveryi/PELP), blocks &, I, L and N [LJ Stbiect retsientto 00 Low, Asia Organced Grime (ROG), Hislon Organized Crimo (OC), RussinwBostern Eurapaan, Canbosan, oF Nigerian Organized Grima Gravp - Complato #O.518a, Side 1 Blacks A-E mandatory, F-H as appropeala, [D) Subject rotztos to on OCiDrug orgaizaton, a VEMO Progtam National Gong Stratoyy torgat group, of wVCMO Progrem National Priority (wtistera terget group =~ Do not indicate $ in Section D G. Child Victim information Child tocaled /identified Date:, CBliving £3 Deceased b7c -1 Seria No. of FD-545 ¥ Requires that an explanation be attached and loaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismanttement, and drug seizures. BIC- Hh ~ /0SRN |