HOUSE_OVERSIGHT_021638.jpg

FD-515 (Rev, 12-19-06) * Accomplishment Report e Date Prepared 29/08 Squad supervisor approval (Accomplishment must be reported and loaded into ‘ Date Loaded (please initial) ISRAA within 30 days from date of accomplishment) Date Loader's Initials Investigative Assistance or Technique Used O62! 2. Helped, minimally 4, Absolutely essential Drugs [S/ . For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO IAT IAT [Finwanaiyst |_| | Aicrattasst. | | | Pen Registers Computer | |ehoiocover | | fetsurrrisc| | |Search Warrant] PT eisunst.it | ll stow voney |_| fero.Fiewse| | [socass. |_| Brrosico EI Ea Pc moxscro | [teoats Asst, | FRM Tech.acieaun| roe-rro || | = O A Fugitive O Bankruptcy Fraud O Computer Fraud/Abuse C) Corruption of Public Official Money Laundering Sub Invest Asst by FO(s) Rate FO Rate FO Rate FO tA Rate FO aT . [| Juco-natooal Bscwervicer| — fil B cin mass] | issn a] ; - InfraGard/CyD Evid. Purchaso| [I Phone Toll Rec| [MNNFL.Mon.-1tc | NN OFCICID invowinfo | | —[uco-Group! | [MMNFor LangAsst. |_| free | fish ov. eam] | uco-croup] venrmiiavex] || | J. Civil Rico Matters Date: Also complete "Section G” Other Civil Matters Date: F, Conviction CL) Federal ([kocal [ Intemational Conviction Date; A. Complaint / Information/ indictment (1Federat [Jlocal [1 Intemational Complaint Date: Check if Civil Rico Complaint Subject Description Code *(__° ie For 6E. G, HeInclude A ud Judicial Outcome__.___ OX Information Date: or Or, G, h-Incluae Agency Co ° Amount $ Indictment Date: [1 Felony or CL] Misdemeanor Suspension: Years Months__ (Plea or 0 Trial B. Locate /Arrest State: Judicial District: [Federal [JLocat [7 International - Subject Priority: TIA OB (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) Debarment or Arrest Date: Title Section # Counts Injunction Year, Months ([] Subject Resisted Arrest (2 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 C. Summons Date: (Federal [[] Local D. Recovery / Restitution / PELP X (Federal D)Locat [7] International Recovery Date: Code * vy Amount $ Code*__ sv = Amount $ Restitution Date: H. Sentence Date: Sentence Type: . M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: Months___ Months____ In Jail: Years. Suspended: Years N. Drug Seizures Vv Date: (Court Ordered {[] Pretrial Diversion Probation: Years Months____. Drug Code * : Code*___esy Amount $ Fines: $ . bo “ee PELP Date: z Do not indicate $ in Section D Code * Y Amount $ |, Disruption/Dismantlement: “ . E. Hostages(s) Released Date: . Disruption Date: Released by: [7] Terrorist (1) Other 0. Child Victim Information Chitd located / identified Date:_O off oproy Dismantlement Date: Phriving _ (Deceased Number of Hostages: Completion of FD-515a Side 2 Mandatory P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, Land N (a a a cee eee eee ees Ol Subject related to an LCN, Asian Organized Crime (AOC}, italian Organized Cnme (IOC), Russian/Easiern European, Caribbean, or Nigerian Organized Crime Group - Complete FD-5152, Side 1 Blocks A-E mandatory, F-H as appropriate, 0 Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targot group, or a VCMO Program Nallonal Priority Initlalive target group - Completa FD-515a, Sida 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 Mo; OLFD-516 e See codes on reverse side, LL tC—“‘C~—sC*SCO 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-MM - (08062-2049 & be b7C bT7E b6 b7C HOUSE_OVERSIGHT_021638