HOUSE_OVERSIGHT_021602

B Vv. 12-19-06) @

quad supervisor approval (please initial)

Accomplishment involves: (check all that apply)

Drugs 0 A Fugitive QO Bankruptcy Fraud O Computer Fraud/Abuse O Corruption of Public Official 0 Money Laundering

Sub Invest Asst by FO(s)

Asst. FO(s) A. B. C. Dz

A. Complaint / Information/ Indictment

(1 Federal EJLocal [J International + Complaint Date:

Check if Civil Rico Complaint [1] Information Date:

Indictment Date:

. Locate / Arrest

(J Federal [Local ([] International -

Subject Priority: OA OB Oc Locate Date:

Arrest Date:

(-] Subject Resisted Arrest

(J Subject Arrested was Armed

. Summons Date: (Federal [[] Local . Recovery / Restitution / PELP X C] Federal Citocal [7] Intemational Recovery Date: Code ® vy Amount $ Code* sy = Amount $ Restitution Date:

() Court Ordered (J Pretrial Diversion

Code*__ sy =Amount $ PELP Date: Code * v Amount $

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

Number of Hostages:

File Number

E-MM-loKoe2

Date Prepared Of Date Loaded Date Loader’s Initials

Accomplishment Report ®

(Accomplishment must be reported and loaded into

ISRAA within 30 days from date of accomplishment) b7c

b7E

Investigative Assistance or Technique Used 1. Used, but did not help 3. Helped, substantially

2. Helped, minimally 4. Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO

Rate FO IAT Rate FO

| Bi AtrcrattAss. | |

Way Rate FO lA Rate FO 1AT

5 Crim/NS Intel Asst CART Asset Forf Prog

SL Coe ~ Ee Ee So

MPoc-iTc | | Bron eT a I co

J. Civil Rico Matters Date:

|_| orisis Hep Local| | _ || -e_ | | |_|

F, Conviction

(7 Federal (Local [J International

Conviction Date: Subject Description Code

e (_._) ®

For 6F, G, H-Inchude Agency Code

Aliso complete “Section G"

Other Civil Matters Date: Judgment.

Judicial Outcome__ OK Amount $

(7 Fetony or (J Misdemeanor

(Plea or () Triat State:____._. Judicial District:

Suspension: Years Months

K. Administrative Sanction Date: ° Subject Description Code G. U.S, Code Violation Type: Length:

Required for sections A, B, F and J : . H

Suspension (7] Permanent

Debarment

(Federal Only) or Injunction Year. Months

Title Section # Counts

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

H. Sentence Date:

Sentence Type: M. Acquittal/ Dismissal/ Pretrial Diversion

(Circle one) Date: In Jail: Years____.___. Months.

Suspended: Years__._t__. Months___ N. Drug Seizures v Date:

Probation: Years... Months. Drug Code *

Fines: $ Weight _______ Code ® FDIN

Do nat indicate $ in Section D

0. Child Victim Information Child located / identified Date: b/ 29 oY

Kuiving : (7 Deceased

|. Disruption/Dismantlement: ~“

Disruption Date: Dismantlement Date:

Completion of FD-515a Side 2 Mandatory

P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, Land N b6

Social Security No. (if available) bic

1 ee ee |

For Indictments/Convictionfonly:

O Subjact related to anfiCN, Asian Organized Crime (AOC), Italian Organized Crime (1OC), Russian/Enstern European, Caribbean, of Nigerian Organized Cnme Group «

Compete FD-515a, Side 1 Blacks A-E mandatory, F-H as appropriate.

oO Subject related to an OC/Drug organization, a VCMO Program National Gang S(rategy target group, or a VCMO Program National Priority initiative target 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

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.

3/IE- UK 10806 2-19 |

~ HOUSE_OVERSIGHT_021602