*;
Pal : D-515 (Rev. 12-19-08)
Squad supervisor approval (please initial)
File Number
Drugs A Fugitive
Bankruptcy Fraud Computer Fraud/Abuse Corruption of Public Official 7] Money Laundering
Sub Invest Asst by FO(s)
Asst. FO(s) A. B.C. D
A. Complaint / Information/ Indictment
((Federat [)Local Complaint Date:
Check if Civil Rico Complaint O
bbooo
(1 International
Information Date:
Indictment Date:
B. Locate / Arrest (Federal [JLocal [7 international - Subject Priority: 1A OB (1c Locate Date: Arrest Date: (2 Subject Resisted Arrest DD Subject Arrested was Armed
Cc. Summons Date: (Federal [] Local
D, Recovery / Restitution / PELP X (]Federal [JLocal [J International Recovery Date: Code * v Amount $ Code * ¥ Amount $ Restitution Dates. [1] Court Ordered {[] Pretrial Diversion
Code* sy = Amount $
PELP Date:
Code*_ ss ¥ «Amount $
E. Hostages(s) Released Date: Released by: [1] Terrorist [1] Other
Number of Hostages:
Accomplishment Report (Accomplishment must be reported and loaded into
ISRAA within 30 days from date of accomplishment)
2, Helped, minimally
1A) Rate FO
° [Finan |_|
ELSUR / FISC ELSUR/T. Ill
[eve Purchase] |
F. Conviction (Federal [Local
Conviction Date:
(JJ Intemational
Subject Description Code
c (a For 6F, G, H-Include Agency Code
(J Felony or (] Misdemeanor
(] Plea or CI Trial State: 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:
'
In Jail: Years.
Suspended: Years. Years.
$
Probation:
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 \AT Rate FO (AT Lab, Field Sup | | | UCO - Nat.Back |_| |__| Pen Renisters | lM cavervicae| |
Proto coer [roversn | P Tsocast_| | [Eton Ta Res | P [invowinio [| [vco-crups |_| tak ov. exam| | |vco-crupit] —
6 29/08 y b6 b7c
b7E
Date Prepared Date Loaded Date Loader’s Initials
3. Helped, substantially 4. Absolutely essential
free Pd
Photo Cover | | fe ERT Asst,
swe |_| on iro | Boros] |
J. Civil Rico Matters Date: Also complete “Section G”
Other Civil Matters Date:
Viet-Witn Coor
Judgment ____ Judicial Outcome. Amount $
Suspension: Years
°x
Months.
K. Administrative Sanction Date: Subject Description Code Type: Length: |_| Suspension (J Permanent
{_.} Debarment or
(} injunction Year. Months
L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory ___ESEE 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:
Months___ Months. Months
N. Drug Selzures Y Date:
Drug Code ® Weight FDIN
Do not indicate $ in Section D
Code *
0. Child Victim Information Child located / identified Date:
PRriving
ofzofpray
(C1) Deceased
P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, L and N
Sex : Date of Birth Social Security No. (if available)
es ee ee ee
Subject related to an LCN, Asian Organized Crime (AOC), Italtan Organized Crime (10C), Russlan/Eastern European, Carlbbean, or Nigetian Organized Came Group -
Complete FO-5152, Side 1 Blocks A-E mandatory, F-H as appropriate.
Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy torgel group, or a VCMO Program National Priority Initiative largel group -
Complele 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 foaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures.
BIE Un (08062 — 194
HOUSE_OVERSIGHT_021608