HOUSE_OVERSIGHT_021588

_ @ E Vv. 12-19-06)

Squad supervisor approval (please initial)

Fite Number

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

A. Complaint / Information/ Indictment

(Federal [jLocal Complaint Date:

Check if Civil Rico Complaint O

(2 Intemational

information Date:

Indictment Date:

. Locate / Arrest [Federal [JLocal ([] International - Subject Priority: OA OB Oc Locate Date: Arrest Date: (CF Subject Resisted Arrest (D Subject Arrested was Armed

. Summons Date: (Federat [Fj Local » Recovery / Restitution / PELP X (Federal [JLocal {7 International Recovery Date: Code * v Amount $ Code*. vy =Amount $ Restitution Date; (] Court Ordered ([] Pretrial Diversion

Code*__yv =Amount $

PELP Date:

Code*__ vy = Amount $

. Hostages(s) Released Date:, Released by: [] Terrorist (] Other

Number of Hostages:

P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, L and N

[ace* | sex | Detain | __ Sol Seariyo (evan) —_| ES A

Asian Organized Crime (AOC), Nalian Organized Cnme (!0C), Russian/Easlern European, Caribbean, or Nigerian Organized Cnme Group =

0 ict IsvUOnvICctio ony: Subject related to. an LCN, Complete FD-515a, Sida 1 Blacks A-E mandatory, F-H as appropriate,

E-MM- 1 oF 062

Accomplishment Report (Accomplishment must be reported and loaded into

ISRAA within 30 days from date of accomplishment)

2. Helped, minimally

1A Rate FO

Aircraft Asst.

| [censen en |_|

| | ecsurst. | |

Eng. Tape Ex. || Legats Asst. Evid. Purchase | |

F. Conviction (C Federal [1 Local

Conviction Date:

C1 International

Subject Description Code *( ye For 6F, G, H-Include Agency Code (1 Felony or

(J Plea or State:

(C1) Misdemeanor

(1 Trial

Judicial District:

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

Title Section # Counts

H. Sentence Date: Sentence Type:

1 '

Years__——. Months Months,

In Jail: Suspended: Years Probation: Years,

Fines; - $

|. Disruption/Dismantlement: “

Disruption Date:

Dismantlement Date:

Completion of FD-515a Side 2 Mandatory

Investigative Assistance or Technique Used 4. Used, but did not help

For Sub, Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO AT Rate FO 1AT

Months________.,

Date Prepared OH, Date Loaded Date Loader’s Initials

3. Helped, substantially 4. Absolutely essential

Rate FO IAT

ree | ;

BB crimis intel Asst] —_| fe Crisis Neg,- Fed | |

Sav-!TC | | JFi.Mon.-17¢ | |

ronraitapse| | |

J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: Judgment Judicial Outcome_______—_—®x Amount $

Suspension: Years Months

K. Administrative Sanction Date: Subject Description Code Type: Length: []Bevamen I Permanent

Debarment Injunction

or Year Months

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

M. Acquittal/ Dismissal/ Pretrial Diversion

(Circle one) Date:

N. Drug Seizures “ Date:

Do not indicate $ in Section D

O. Child Victim Information Child located / identified’ Date: b/ Bo) oY

beLiving (D Deceased

Code *

0 Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targel group, or a VCMO Program National Priority fnilialive target group -

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,

Serial No. of FD-515

¥ Requires that an expianation be attached and loaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures.

BlE- MM -~ (o80b2~ 18 ¥

HOUSE_OVERSIGHT_021588