S
SisiPev. 12-19-06)
“Squad supervisor approval (please. initial)
Accomplishment Report
(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)
Accomplishment involves:
4. Used, but did not help (check all that appl File Number :
Orgs ED (SIE=mm=(0k Oz 2, Helped, minimally A Fugitive O
Bankruptcy Fraud C) IAT Rate FO Computer Fraud/Abuse O ; | Fin.Analyst |_| Corruption of Public Official BM Aircrattass. |_|
| _Squad__| rest FO)_____] (PCGUAL Pe |
, Bae
Eng. Tape Ex.
A. Complaint / Information/ Indictment
(Federal [Local
Complaint Date:
F. Conviction Cl Federal [Local
Conviction Date:
(1 Intemational CD International
Check If Civil Rico Complaint [1] Subject Description Code
e (——__-_)* For 6F, G, H-Include Agency Code (Felony or
(Plea or State:
Information Date: (J Misdemeanor
0 Triat Judicial District:
Indictment Date:
. Locate / Arrest (Federal [)Local (1 International:
Subject Priority: (JA [8 [Jc Locate Date:
G. U.S. Code Violation Required for sections A, B, F and J (Federal Only)
Title Section # Counts
Arrest Date: (J Subject Resisted Arrest ( Subject Arrested was Armed
. Summons Date: (J Federai (J Local
. Recovery / Restitution / PELP X Federal [LJLocal = [7] International
| | Recovery Date: | :
H. Sentence Date: Sentence Type: Code * v Amount $ Code*_ v= Amount $ | , Restitution Date: a (Court Ordered [] Pretrial Diversion Code * yY Amount $ PELP Date: Code *
Months. Months___ Months__
In Jail: Years. Suspended: Years. Probation: Years,
Fines: $
v Amount $ |. Disruption/Dismantlement: v
| | E. Hostages(s) Released Date: . ' ! Disruption Date:
Released by: [1] Terrorist (1) Other Dismanttement 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
Investigative Assistance or Technique Used
For Sub. invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO
IAT | [Pen Resistors || | ehotocover |_| |_| Search Warrant | [socAss. | Tech. Ag/Equip. [invewinto [| | | UCO - Group!
Date Prepared OF 24 y
Date Loaded b6é Date Loader’s Initials b7C
bT7E
3. Helped, substantially 4. Absolutely essential
Rate FO 1A Rate FO AT
° | Juco-narsoa | ; ucaver vicar] | Biss Non Fe Burro | [eee] tt
J. Civil Rico Matters Date: Also complete “Section G”
Other Civil Matters Date:
Judgment Judicial Outcome___.___ OX
Amount $
Suspension: Years Months.
K. Administrative Sanction Date: Subject Description Code Type: | Length: . Suspension ([] Permanent Debarment or
Injunction Year Months
L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory ___SE 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 FDIN
Do not indicate $ in Section D
0. Child Victim Information Child located / Identified Date:_O of opeay Ph riving (7) Deceased : [|
Cade *,
[ Racet [Sex [bsborpin Ses oawy no avioby | Po Os
Subject related fo an LCN, Asfan Organized Crime (ACC}, Italian Organized Cnma (!0C), Russlan/Eastern European, Caribbean, or Nigerian Organized Came Group -
Complete FD-515a, Sida 1 Blocks A-E mandatory, F-H as appropriate.
Subject related to an OC/Drug organization, a VOMO Program National Gang Slrategy targel group, or a VCMO Program National Priority Initiative targel group -
Complete FD-515a, Side 1 Blocka 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 |SRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures.
3/E-HM -(0§062- (fe
HOUSE_OVERSIGHT_021616