FD-515 (Rev. 12-19-06) Accomplishment Report Date Prepared Squad supervisor approval (Accomplishment must be reported and loaded into Date Loaded (please initial) ISRAA within 30 days from date of accomplishment) Date Loaders Initials
Investigative Assistance or Technique Used
Fite Number 1. Used, but did not help 3. Helped, substantially D 2. Helped, minimally 4. Absolutely essential nee = For Sub, Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO ugitive Bantruptey Fraud a aT Rate FO Rate FO aT Rata FO IAT
aT [Proto cover | MMcimnisint ase | [crisis Neg Feel |
Computer Fraud/Abuse Oo Corruption of Public Officiat 1 Money Laundering
Sub Invest Asst by FO(s)
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Computer
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Sc Y | “ me Swat Team mm © PRM Leoats asst. [PRM tech. Aazcuin| | |__| Evid. Purchase] A Phone Tot Reo| [| Jwewieie | —|__[veo=croupt | fm Fo: tena cst |_|
[126.0 Exam] | _[uco-croueit] — flifvonraitavex| | |
J. CivilRico Matters Date: Also complete "Section G"
Other Civil Matters Date:
Sav - ITC
[ree Yd
F, Conviction (Federal []Local [1] Intemational
Conviction Date:
A. Complaint / information/ Indictment
(Federal ([JLocal [1 Intemational Complaint Date:
Check If Civil Rico Complaint C1 Subject Description Code *(__)* SLE eee Forde 28, Hepehuenk Sed Judicial Outcome___.§. ____ OX information Date: Or Oh. rieineluee Agency Vo ° Amount $ Indictment Date: = Felony or 5 MISAEMeanGr Suspension: Years Months___ Plea or Trial
B. Locate / Arrest State: Judicial District:
C] Federat ([JLocat [{(] International : Subject Priority; OOA (1B Cc
K, Administrative Sanction Date: Subject Description Code ® Type: . Length:
G. U.S. Code Violation
Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Onty) Debarment or Title Section # Counts Injunction Year. Months
Arrest Date: (1) Subject Resisted Arrest (2) Subject Arrested was Armed
L. Asset Seizure Date:. Asset Forfeiture Date: CATS # Mandatory.__ESE Circle below one of the three asset forfeiture:
Admin, Civil Judicial, or Criminal
C. Summons Date:
(Federal [J Local
. Recovery / Restitution / PELP X [Federal [Local [International Recovery Date:
Code * vy Amount $ Code*__ sv) Amount $
Restitution Date:
Do not indicate $ value in Section D
H. Sentence Date:
Sentence Type: PY M. Acquittal/ Dismissal/ Pretrial Diversion
(Circle one) Date:
In Jail: Years Months_____
Suspended: Years___._.__. Months______ N. Drug Seizures Y Date:
(1) Court Ordered] Pretrial Diversion Probation: =“ Ysate Mentha. Drug Code © . Code*__ v= Amount $ Fines: § ot Code 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
O. Child Victim Information Child located / identified Date: Oey ofroy
Phriving (CO 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
Ls
Subject related to an LCN, Asian Gfganized Crime (AOC), Italian Organized Cnme (10C), Russian/Eastern European, Carlhbean, or Nigerian Organized Crime Group - Complate FD-515a, Side 1 BlockgA-E mandatory, F-H as appropriate.
Subject ralalod to an OC/Drug organization, a VCMO Program National Gang Strategy targal group, or a VCMO Program National Priority Iniliative target group - Complate 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. petial No: of ho Sle
= Sau colleen eames Bea, [
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,
GVE-UK — 108062- 199
HOUSE_OVERSIGHT_021618