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s x Squad supervisor approval (Accomplishment must be reported and loaded into . Date Loaded _& (please initial) ISRAA within 30 days from date of accomplishment) “= |; 12-19-06) * Accomplishment Report Date Prepared CH, Z (6) Date Loader's Initials Investigative Assistance or Technique Used Asst. FO(s) A.B. C. OD. pecsur/t.i | MME snow Money |_| fenariaset| | [sooasst | Eo | Evid, Purchase] | , Phone Tall Rec eran, |_| outst |_| sav- |_| Poo. |_| Fone |_| [_[uc0-crovot | I Foc tanonest | fal rrr | [ise oi Exam | [uco- croup] lvonsmitepes| [| J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: Fort Support Pro] CxSICTD 1. Used, but did not help 3. Helped, substantially D 2. Helped, minimally 4, Absolutely essential mugs O For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO A Fugitive O Bankruptcy Fraud im IAT Rale FO IAT Rate FO IAT Rate FO IAT Computer FraudiAbuse fist retisup | | _[uco-retoeak] im a of Public Official 1 | _|PenRegisters | | NCAVGI Vi-CAP | | 10 Wanted Flyer Hath it [Photo Cover | Joximmus init ass] SARs | noto C: J Sub Invest Asst by FO(s) | | Photo Cover | MMMM Grimms Intel Asst] NINN SARs | Consen Mon, | | BME Ciisis Neo. Fea] im F, Conviction 1 Federal E)Locat {2 Intemational Conviction Date: A. Complaint / Information/ Indictment [] Federal [JLocal (1 Intemationat Complaint Date: Check if Civil Rico Complaint C1 Subject Description Code *(_—_) SITE arene , ee Eni Judicial Outcome__ OX Information Date: or Include Agency Code Amount $ Indictment Date: C) Felony ad [1 Misdemeanor Suspension: Years Months (1 Plea or OD Triat B. Locate / Arrest State: Judicial District: (Federal [Local [International - Subject Priority: TIA O18 Oc K. Administrative Sanction Date: Subject Description Code a Type: Length: G. U.S. Cade Violation Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Only) 4 Debarment or Arrest Date: Title Section # Counts Injunction Year Months C1 Subject Resisted Arrest (J Subject Arrested was Armed L. Asset Seizure Date:. Asset Forfeiture Date: CATS # Mandatory —__ Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D Cc. Summons Date: (Federal [1] Local . Recovery / Restitution / PELP X (Federal ([Jlocal [J international Recovery Date: Code * v Amount $ Code*. sey =Amount $ Restitution Date: H. Sentence Date: Sentence Type: ° M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: _. In Jail: Years Months. Suspended: Years______ Months N. Drug Seizures “ Date: (1) Court Ordered [[) Pretrial Diversion Probation: Years Months___. Drug Code ° . Code * Y Amount $ Fines: $ Weight ________ Code PELP Date: FDIN mee ’ Do nat indicate $ in Section D Code * v¥ Amount $ [. Disruption/Dismantlement: Vv . Hostages(s) Released Date: Disruption Date: Released by: [[] Terrorist [] Other O. Child Victim Information Child located / identified Date: 6 20) oy Dismantlement Date: 5 Number of Hostages: , Yui i D d Completion of FD-515a Side 2 Mandatory: any - CBecsase > P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, Land N (—$—— —] Race® | Sex | Date of Bi Social Security No. (if available) a se ee 0 Subject related to an LCN, Asian Organzed Crime (ACC), Stalian Organized Crima (IOC), Russian/Easlern European, Caribbean, or Nigenan Organized Crime Group - Complete FD-518a, Side 1 Biocks A-E mandatory, F-H as appropriate, 0 Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy targel group, or a VCMO Program National Priority Inlialive target group = Completa F0-515a, Side 1 Blocks A-C only, x Additional information may be added by attaching another form or a plain sheet of paper for additional entries. Serial Noel FE b16 e See codes on reverse side. [oe Y Requires that an explanation be attached and foaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures. BIE-MH- [08062 ~ 18) O& bé b7c bTE HOUSE_OVERSIGHT_021582