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a FD-515 (Rev. 12-19-06) @ Squad supervisor approval (please initial) Accomplishment involves: (check all that apply) Computer Fraud/Abuse Corruption of Public Official Money Laundering Sub Invest Asst by FO(s) [1] Asst. FO(s) A. B.C. Dz i A, Complaint / Information/ Indictment [Federal [Local Complaint Date; (1 Intemational Check if Civil Rico Complaint (J Information Date: indictment Date: . Locate / Arrest [Federal [Local Subject Priority; JA 1B Locate Date: fic Arrest Date: (2 Subject Resisted Arrest (2 Subject Arrested was Armed . Summons Date: (i Federat [7] Local . Recovery / Restitution / PELP X (Federat [Local [] Intemational Recovery Date: : Code * v. Amount $ Code ° yY Amount $ Restitution Date: [1 Court Ordered = ([] Pretrial Diversion Code* sy =Amount $ PELP Date: Code*__ sy =Amount $ E. Hostages(s) Released Date: Released by: [1] Terrorist (7) Other Number of Hostages: P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, Land N Dect N File Number (1) International - Accomplishment Report (Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment) IAT Rate FO BE Finanayst | | yfesunre |_| Bn. Tne Ex | | i. ures [cw iio F, Conviction 1 Federal (Local Conviction Date: (1 Intemational Subject Description Code *(__) For 6F, G, H-Include Agency Code (] Felony or (1 Misdemeanor (0 Plea or (1 Trial State: Judicial District: G. U.S, Code Violation Required for sections A, B, F and J (Federal Only) Title Section H, Sentence Date: Sentence Type: In Jail: Years. Suspended: Years Probation: Years, Fines: $ |. Disruption/Dismantlement: Disruption Date: Dismantlement Date: Completion of FD-515a Side 2 Mandatory Investigative Assistance or Technique Used 1. Used, but did not help 2. Helped, minimally For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO IAT | AircraftAsst, | | | Pen Registers | | = Geet [| [eensen ion | MM Poverenn | | feusurvrisc| | [search warrant] | | SoG Asst__| | | [UCO- Group | Lab, Div.Exam| | |uco-croup |_| Date Prepared O 4/29 of Date Loaded _ "30/0" b6 Date Loaders Initials |__| b7Cc b7E 3. Helped, substantially 4, Absolutely essential Rate FO \AT Rate FO IAT [| Juco-narsoce] — QM vestan coor | Be crimus intet ass | Crisis Neg.- Fed! | | Crisis Neg.- Local | | : Forf Support Proj BOBERTAsst || Meute-1c | fi TFOSICTD CXS/OTD fe Sav - ITC || Poc-ITc | NE InfraGard/CyD OFCICID lee - | | | occ Biccrae| | | J. Civil Rico Matters Date: Also complete “Section G" Other Civil Matters Date: Judgment —__ Judicial Outcome____» OX Amount $ Suspension: Years Months___ K, Administrative Sanction Date: Subject Description Code Type: Length: Fetement C1 Permanent Debarment or Months Injunction Year, L. Asset Seizure Date: Asset Forfeiture Date; CATS # Mandatory _EE Circle below one of the three asset forfeiture: ‘Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: Months___ Months____ Months______. N. Drug Seizures “Date: Drug Code ® Weight FDIN Do not indicate $ in Section D 0. Child Victim Information Child located / identified Date: oof ofroy PRiving (J Deceased Code” b6 b7C [| fee? | Sex [ _, Datoofoin | Sasi Sreviyna avai) | OS ces Bialea to a TAsion Urganized Came (AGC), Complete FD-515a, Sida 1 Blocks A-E mandatory, F-H as appropriale. oO Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targol group, or a VCMO Program National Priority Initialive target group ~ Complete FO-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. e See codes on reverse side. ‘allan Organized Came (IOC), Russian/Eastern European, Caribbean, or Nigeran Organized Crime Group - Serial No, of FD-515 v Requires that an explanation be attached and loaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures. BIE- MH - (08062 - 200 HOUSE_OVERSIGHT_ 021620