HOUSE_OVERSIGHT_021606

@ Date Prepared

Vv. 12-19-06) Accomplishment Report "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 4. 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

File Number

Rate FO IAT Rate FO 1A Rate FO (AT

aT T

O O Bankruptcy Fraud {) Computer Fraud/Abuse O Corruption of Public Official 0 Money Laundering Sub Invest Asst by FO(s)

| [eusurvrisc| | [search Warrant] MMEGisis Nop Local] | || evsur/T. tt | [show Money | MMMerTass, | feng. Field Set] | |socass. |_| Eng. Tepe Ex | [MM swatTeam | MM sav-irc | |B Tech. Agrecuin.| | [FB Phone Tou Rec | MM Ft. Mon. 170

[tsb oem] | _[uco-couet] —flinonreiuabex] |

F. Conviction J. Civil Rico Matters Date:

Also complete “Section G” Other Civil Matters Date:

(Federat [Local [1 Intemational

Conviction Date:_

A. Complaint / information/ Indictment

CiFederat ([Jtocal [1] International Complaint Date:

: ooge es Check if Civil Rico Complaint [1 Subject Description Code *(__* het aan —_—— : udicial Outcome OX Information Date: For 6F, G, H-Include Agency Code Amount $ Indictment Date: ‘ 5 ne or 5 a Suspension: Years Months___, Plea or rial

State: Judicial District:

K. Administrative Sanction Date: Subject Description Code = Type: Length:

B. Locate / Arrest (Federal [JLocal [(] International:

Subject Priority. OA OB fic

G, U.S, Code Violation

Required for sections A, B, F and J Suspension {] Permanent Locate Date: (Federal Only) A Debarment or Injunction Year. Months

Arrest Date: Title Section # Counts

(-] Subject Resisted Arrest (DF 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

C,. Summons Date:

(Federal [[] Local

D, Recovery / Restitution / PELP X ()Federat [Local [1] International Recovery Date: Code * vy Amount $ Code*_ ev =Amount $ Restitution Date:

Do not indicate $ value in Section D

H. Sentence Date:

Sentence Type: ’ ° M. Acquittal/ Dismissal/ Pretrial Diversion

(Circle one) Date:

Months, Months_____

in Jail: Years,

Suspended: Years,

N. Drug Seizures VY Date:

(] Court Ordered {[ Pretrial Diversion Probation: Years Months___ Drug Code * =

| Code*_ sv = Amount $ Fines: $ eo eons PELP Date: ° Do not indicate $ in Section D Code * v¥ Amount $ |. Disruption/Dismantlement: Vv

E. Hostages(s) Released Date:

: Disruption Date: Released by: [1] Terrorist [) Other

0. Child Victim Information , Child located / identified one. 06 ofray

Phriving _ [1 Deceased

Dismantlement Date:

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

1 ae ee

Social Security No. (if available)

Sree Te n o e pray crpanized Crime (1OC), Russlan/Eastern European, Caribbean, or Nigerian Organizad Crime Group - Complete FD-5158, Sida 1 Blocks A-E mandatory, F-H as appropriate.

Subject related to an OC/Drug organization, s VCMO Program National Gang Stralegy target group, or a VCMO Program National Priority Inillalive target group - Completa 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. Belial IO; of POG IG

« See codes on reverse side, | tti“‘“CCSCS*S*=*C

v Requires that an explanation be attached and foaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures,

FH EU (0806 2-48

HOUSE_OVERSIGHT_021606 |