FD-515 (Rev. 12-19-06) 6
Squad supervisor approval (please initial)
Drugs {] A Fugitive oO Bankruptcy Fraud. oO Computer Fraud/Abuse O
Corruption of Public Official Money Laundering Sub Invest Asst by FO(s)
Asst. FO(s) A. B.C. Dz
File Number
| S/-Mm-/O¥ O67}
Accomplishment Report
(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)
2. Helped, minimally
Rate FO
1A Pi
1. Used, but did not help
For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO
Pen Registers
Date Prepared x Date Loaded r Date Loader's Initials b6 : b7c investigative Assistance or Technique Used b7E
3. Helped, substantially 4. Absolutely essential
\AT UCO - Nat.Back| NCAVC/ Vi-CAP Crim/NS Intel Ass
0 Crisis Neg.- Local ERT Asst, Butte - ITC Sav - ITC
Ft. Mon. - ITC
Inf/CW Info
Lab. Div. Exai
For, Lang Asst.
& By 9 5 9 cy bas ne 2 g a Z B ie nn By HA
Lo
ey
tJ
‘T iT \. Polygraph
i i Tech, gl=quip 5
Phone Toli Red
UCO - Group |
: UCO - Group Ill J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date:
A. Complaint / Information/ Indictment
C1 Federal (Local [[] International Complaint Date:
. Check if Civil Rico Complaint C1] iit: leer eee
Judicial Outcome. a X Amount $ Suspension: Years Months
Information Date: Indictment Date:
or 0 Tria State: EC. Jucicial District: K. Administrative Sanction Date: Subject Description Code
G. U.S. Code Violation Type: Length: Required for sections A, B, F and J ‘ : Suspension [[] Permanent
d Locate¢'Arrest> C1] Federal Local [[] International!
Subject Priority: CJA OB Ke
Locate Date: (Federal Only) Debarment or
Arrest Date: OG fa) Title Section # Counts Injunction Year. Months
(1) Subject Resisted Arrest (CJ Subject Arrested was Armed
L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory
. Summons Date: Circle below one of the three asset forfeiture:
ClFederat [[] Local Admin, Civil Judicial, or Criminal
—— Do not indicate $ value in Section D » Recovery / Restitution / PELP X
(] Federal ([JLécal [1] International Recovery Date:
Code * vy Amount $__ Code*®___sy Amount $
Restitution Date: [] Court Ordered (J Pretrial Diversion Code * Y Amount $e Fines: $ PELP Date:
Code * v Amount $
H. Sentence Date:
Sentence Type: M. Acquittal/ Dismissal/ Pretrial Diversion
s (Circle one) Date: In Jail: Years______. Months,
Suspended: Years.____ Months______ N. Drug Seizures “ Date:
Probation: | Years______ Months, Drug Code * Weight ______ Code ® FDIN =
Do not indicate $ in Section D
1. Disruption/Dismantlement: Y
E, Hostages(s) Released Date: O. Child Victim Information
Child located / identified Date:
Disruption Date:
Released by: [] Terrorist (1) Other Dismantlement Date:
Number of Hostages: ____S (Living
D Completion of FD-515a Side 2 Mandatory (TDensased
P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, Land N
[tong ——*dCRaet|sex | Datootbith_——‘|_—_—Sosel Sono Taio) | J2Wrey Epstem [Ol lel /zo/iass [ato-Wi~ 3348
For tndictments/ (66) viclions only: Subject relaled to an LCN, Asiaf Organized Crime (ACC), Italtan Organized Cnme (IOC), Russian/Eastern European, Caribbean, or Nigerian Organized Crime Group + Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate. . 0 Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy targa! group, or a VCMO Program National Priority (nitialive largel group = Complate 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. penal Novol Fete
e See codes on reverse side. Po
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.
ale- Hh ~ /08062-/ 76
HOUSE_OVERSIGHT_021571