HOUSE_OVERSIGHT_021584

‘Squad supervisor approval (please initial)

Accomplishment involves: (check all that apply)

O O Bankruptcy Fraud Oo Computer Fraud/Abuse Corruption of Public Official [1 Money Laundering Sub Invest Asst by FO(s)

Asst. FO(s) A.B. CG. OD.

A. Complaint / information/ Indictment

(C)Federat [Local [7] International Complaint Date:

Check if Civil Rico Complaint 1 information Date:

Indictment Date:

. Locate / Arrest

(C)Federal [Local {( International -

SubjectPriorty: OA OB Oc Locate Date:

Arrest Date:

( Subject Resisted Arrest

{J Subject Arrested was Armed

. Summons Date: (Federal [[] Local

. Recovery / Restitution / PELP X (J) Federal [Local [J International Recovery Date: Code * vy Amount $ Code*__yv =Amount $ Restitution Date:

[-] Court Ordered ([] Pretrial Diversion

Code*_ ss ¥ =Amount $ PELP Date:

Code*__ ¥ ~Amount $ E. Hostages(s) Released Date:. Released by: [[] Terrorist [7] Other

Number of Hostages:

P. Subject Information - Required for all blocks excluding block D.(Recovery/PELP), blocks E, |, Land N

For indictments/Convictions only:

- v. 12-49-06) @

File Number

Accomplishment Report (Accomplishment must be reported and loaded into

ISRAA within 30 days from date of accomplishment)

2. Helped, minimally

Rate FO 1A

T Fin, Analyst | |

Consen Mon. ||

Evid. Purchase | |

F. Conviction C1 Federal ClLocat [1] Intemational

Conviction Date:

Subject Description Cade *(i_)* For 6F, G, H-Include Agency Code (1 Felony or (J Misdemeanor

(Plea or Tria! State:________.. Judicial District:

G. U.S. Cade Violation Required for sections A, B, F and J (Federal Only)

Title Section

H. Sentence Date: Sentence Type:

' '

In Jail: Years___.__. Months,

Suspended: Years__ttttu. Months...

Probation: Years.___._.. Months,

Fines: $

1, Disruption/Dismantlement:

Disruption Date: Dismantlement Date:

Completion of FD-515a Side 2 Mandatory

4. Used, but did not help

. | Aircrattasst. | |_| Pen Registers | | | Computer | | | Photo Cover || |_|

Pexsun/risc | || seh waren Been | [eocren | i a

Date Prepared OH 29/0 i

b7E Investigative Assistance or Technique Used 3. Helped, substantially 4, Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Rate FO Rate FO AT Rate FO IAT fp NCAVCY Vi-CAP ee (0 Wanted Flyer MB crimms intet Asst] MESARS {crisis Neg Fed| | Crisis Neg.- Local [show Money | AMMerr Asst, | MMM For! Support Pol Pevto-imc || jswatteam | MM sav-rro | [Phone TolRec | MMEFLMon.-iTo | | ca Sa NonFaltabex| | | | J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: Judgment Judicial Outcome, —— —_"% Amount $ Suspension: Years Months K, Administrative Sanction Date: Subject Description Code Type: Length: Suspension (—] Permanent Debarment or # Counts Injunction Year, Months L. Asset Seizure Date: Asset Forfelture 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: N. Drug Seizures “ Date: Drug Code * Weight _____. Code * FDIN Do not indicate $ in Section D O. Child Victim Information Child located /identified Date: bf 29 OX WeLLiving (Deceased b6 b7C

Sex Date pf Birth Social Security No. (if available)

Oo Subjact related to an LCN, Asion Organized Crime (AOC), tlalian Organized Crima (IOC), Russian/Enstern European, 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 organization, a VCMO Program Notional Gang Strategy targol group, or a VCMO Program National Priority Inilialive targel group -

Complete 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.

e See codes on reverse side.

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.

BIE-UH- (06062 ~ | P2

HOUSE_OVERSIGHT_021584