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‘ * , FD-515 (Rev. 12-19-06) ®@ Accomplishment Report ° Date Prepared 29/0 ig Squad supervisor approval (Accomplishment must be reported and loaded into Date Loaded 20 / OF (please initial) ISRAA within 30 days from date of accomplishment) Date Loader’s Initials Investigative Assistance or Technique Used File Number 1. Used, but did not help 3. Helped, substantially — 7 3/€-MIM~- 1648 C62! 2. Helped, minimally 4, Absolutely essential Fugitive A For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Banuptey Fraud oO | Rate FO IAT Rate FO IAT Rate FO AT Rata FO IAT b6 Computer Frawiabuse [eevee | MMcnrecso | | Juco-nawoal on Corruption of Publ Offctat BR conasst [| [Penensore | _ Ili oaver vicar] | PoE [consenivon | A Povcroh | [i cass en reol | 1 Pecsunveisc | | |seorenwarant| Movs ta Loca | ae) Pexsure. | Al stow voney | fMMewrasx. |_| me Butte - ITC Sav - ITC Poc- ITC Ft. Mon. - ITC [ere Td Eng. Tape Ex. | | swat Team |_| Teh. tease | | [ Evid. Purchaso| III Phone Tou Reo| | [tsb bv. xem] | [uco-Groupn] J. Civil Rico Matters Date: Also complete “Section G" Other Civil Matters Date: F. Conviction (Federal ([JLocat [7] Intemational Conviction Date:, A. Complaint / Information/ indictment (JFederat [Local { International Complaint Date; Check If Civil Rico Complaint Subject Description Code *(—_)* Judgment ——. ——_—__.___* —a Cod Judicial Outcome. OK Information Date: or oF, G, r-inciude Agency Co ° Amount $ Indictment Date: 5 PReany or 5 aaa Suspension: Years Months__ Plea or rial B. Locate / Arrest State: Judicial District: (Federal [JLocal [[] International : Subject Priority, OA 4B Oc K. Administrative Sanction Date: Subject Description Code * Type: Length: G, U.S. Code Violation Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Only) A Debarment or Arrest Date: Title Section # Counts Injunction Year. Months. (1 Subject Resisted Arrest (3 Subject Arrested was Armed L. Asset Seizure Date:. Asset Forfaiture Date: CATS # Mandatory Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal o . Summons Date: (Federal [[j Locat . Recovery / Restitution / PELP X (Federal [Local [1 international Recovery Date: Code * vy Amount $ Code*__syv =Amount §$ Restitution Date: Do not indicate $ value in Section D H, Sentence Date: - M. Acquittal/ Dismissal/ Pretrial Diversion Sentence Type: . (Circle one) Date: Months Months. In Jail: Years, Suspended: Years N. Drug Seizures V Date: (Court Ordered [Pretrial Diversion Probation: Years Months__ Drug Code ° Code * ¥ Amount $ Fines: $ i s Code PELP Date: é Do not indicate $ in Section D Code * v Amount $ |. Disruptlon/Dismantlement: Vv E. Hostages(s) Released Date:, Disruption Date: Released by: [1] Terrorist [-] Other O. Child Victim Information Child located / identified Date: off opray Dismantlement Date: PRuiving _ [Deceased Number of Hostages: Completion of FD-515a Side 2 Mandatory P, Subject Information - Required for ail blocks excluding block D (Recovery/PELP), blocks E, 1, Land N b6 | | | Race* | Sex | Date of Birth Social Security No. (if available) b7c oO Subject related to an LCN, Aslan Organized Crime (AOC), italian Organized Crime (10C), Russian/Easlern Evropsan, Caribbean, or Nigerian Organized Came Group + Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate. oO Subject related to an OC/Drug organizalion, a VCMO Program National Gang Slrategy target group, or a VCMO Program Nalional Priority Initiative target group - Complata FD-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 No. of FD-515 e See codes on reverse side. [| 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. 3/E-MH - 198062- 202 ~ HOUSE_OVERSIGHT_021624