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Accomplishment involves: (check all that apply) 1. Used, but did not help 2. Helped, minimally File Number [E-NM-/6% Stat Agent Name q R | Rate FO Bankruptcy Fraud VAT Rate FO Computer Fraud/Abuse Corruption of Public Official Money Laundering Sub Invest Asst by FO(s) Computer || Consen Mon. | | DOOODoOoO TRA | Squad Asst. FO(S) PUA PR-2 pecsur/Fisc| | |Search Warrant] __| A. B. C. D. | | | | Show Money 4 Eng. Tape Ex. os] J [evs Purchos| ne eee a F, Conviction A. Complaint / Information/ indictment (lFederal [Local [J International [Federal [Local [J International Conviction Date: Complaint Date: ELSUR/T. Ill Check If Civil Rico Complaint 1 Subject Description Code a ° Information Date: For 6F, G, H-Include Agency Code indictment Date: (Felony _ or (1 Misdemeanor (0 Plea or OD trial B. Locate / Arrest State: Judicial District: []Federal [JLocat [7 International Subject Priority: OA (1B Oc Locate Date: G, U.S. Code Violation Required for sections A, B, F and J (Federal Only) Title Section # Counts Arrest Date: Z (7) Subject Resisted Arrest (1) Subject Arrested was Armed C. Summons Date: (} Federal [([] Local . Recovery / Restitution / PELP X (Federal [Local [7 International Recovery Date: Code * vy Amount $_ Code * ¥ Amount $ Restitution Date: eens (Court Ordered (FJ Pretrial Diversion Code* Y= Amount $ PELP Date: Code*_ sv = Amount $ H. Sentence Date: Sentence Type: . In Jail: Years Months____.___ Suspended: Years___... Months, Months____ Probation: Years Fines: $ 1. Disruption/Dismantlement: V E. Hostages(s) Released Date: Disruption Date: Released by: ([] Terrorist ([} Other Dismantlement Date: Number of Hostages: Completion of FD-515a Side 2 Mandatory P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks &, |, Land N Subjact related to an LEN, 4 Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate, 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. SAT 7 Lab. Field Sup Aircraft Asst. | Pen Registers [| Photo Gover | | [ovyerepn | | Swat Team [uco-Group| | J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: a a & * B Vv, 12-19-06) Accomplishment Report quad supervisor approval (Accomplishment must be reported and loaded into please initial) ISRAA within 30 days from date of accomplishment) Investigative Assistance or Technique Used For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Judgment Judicial Outcome x Amount $ Suspension: Years K. Administrative Sanction Date: Subject Description Code a Type: Injunct L, Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory .__ EE Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal Do nat indicate $ value in Section D (Circle one) Date: N. Drug Seizures “ Date: Drug Code ® Weight FDIN Do not indicate $ in Section D 0, Child Victim Information ted /identified Date: 0fzofroy Child loca’ PRriving 0 Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targel group, or a VCMO Program National Priority Initiative targel group - Rate FO lar Rate FO [AT | | Juco-natBack] | Suspension ([] Permanent Debarment or M. Acquittal/ Dismissal/ Pretrial Diversion Social Security No. {if available) 4 U ASian Organized Crime (AOC), Slallan Organized Cnme (IOC), Russian/Easiern European, Caribbean, or Nigerian Organized Crime Group - Date Prepared 9/0 & b6 Date Loaded A Os Date Loader’s Initial: bic 3. Helped, substantially 4, Absolutely essential Viet-Witn Coor {0 Wanted Flyer Bicavervicar] | BB crimmis inet asst] | Crisis Neg.- Fed! || Crisis Neg.- Local 5 free ___| Pd jsv-rc | Bb Fe nga |_| Bronranave| |_| Months. Length: ion Year. Months Code ° (1 Deceased b6 b7C Serial No, of FD-515 ¥ 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 - {08062 - 20g HOUSE_OVERSIGHT_021632