a FD-515 (Rev. 12-19-06) Squad supervisor approval (please initial)
Accomplishment involves: (check all that apply)
Computer Fraud/Abuse Corruption of Public Official (1 Money Laundering
|
Sub Invest Asst by FO(s) Asst. FO(s) A. 8. C.D.
i A, Complaint / Information/ Indictment
[Federal [Local Complaint Date;
(1 Intemational
Check if Civil Rico Complaint [J Information Date: indictment Date:
B. Locate / Arrest [Federal [Local
Subject Priority; [JA [1B Locate Date:
fic
Arrest Date: (2 Subject Resisted Arrest (2 Subject Arrested was Armed
Cc. Summons Date: (i Federat [7] Local
D. Recovery / Restitution / PELP X (Federat [Local [] Intemational Recovery Date: : Code * v. Amount $ Code ° y¥ Amount $ Restitution Date:
[1 Court Ordered ([] Pretrial Diversion
Code* ey =Amount $
PELP Date:
Code*__ y= Amount $
E. Hostages(s) Released Date: Released by: [1] Terrorist (7) Other
Number of Hostages:
P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, Il, Land N
RDrCt N
File Number
(1) International -
Accomplishment Report
(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)
tAT Rate FO
BE Finanayst | |
esr |_| Bn. Tne Ex eo cw io |
F. Conviction [1 Federal (Local Conviction Date:
(1 Intemational
Subject Description Code *(__) For 6F, G, H-Include Agency Code (] Felony or (7 Misdemeanor
(J Plea or (Trial State: Judicial District:
G, U.S, Code Violation Required for sections A, B, F and J (Federal Only)
Title Section
H, Sentence Date: Sentence Type:
In Jail: Years.
Suspended: Years Probation: Years,
Fines: $
|. Disruption/Dismantlement:
Disruption Date: Dismantlement Date:
Completion of FD-515a Side 2 Mandatory
Investigative Assistance or Technique Used 41. Used, but did not help
2. Helped, minimally For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO
IAT J vircrattAsst, | | | Pen Registers | | = eset [| [eensenton | I Poverenn | | feusurvrisc| | [search warrant] | Show Money | socasst | | | [UCO- Group | Lab, Div.Exam] | Juco-croupn |_|
Date Prepared O 9/29 of
Date Loaded _ "30/0 b6 Date Loaders Initials |__| b7Cc b7E
3. Helped, substantially 4, Absolutely essential
Rate FO \AT Rate FO 1AT [| Juco-nasoa] BE crimus intt ass | }orsis Nea Fed| | crisis Neg Local | |
BPERT Asst || Meute-1rc | [EE TFOSICTO CXS/CTD
me Sav - ITC || Poc-ITC | NE InfraGard/CyD OFCICID
lee | .
= _ _ occ Brcorae| ||
J. Civil Rico Matters Date: Also complete “Section G"
Other Civil Matters Date: Judgment
Judicial Outcome__ —_ eX Amount $
Suspension: Years Months__
K, Administrative Sanction Date: Subject Description Code Type: Length: Fetament C1 Permanent Debarment or Months
Injunction Year,
L. Asset Seizure Date: Asset Forfeiture Date; CATS # Mandatory __EE 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 Seizures “Date:
Drug Code ® Weight FDIN
Do not indicate $ in Section D
0. Child Victim Information Child located / identified Date: oofg ofroy
PRiving (J Deceased
Code”
b6 b7C
[| feces? | Sex [_, Datofoun | Seal Sreviyna aaa) | OS ces
Bialed to a Asian Organized Came (ACC), Complete FD-515a, Sida 1 Blocks A-E mandatory, F-H as appropriale. oO Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targol group, or 3 VCMO Program National Priority Initialive target group ~
Complete FO-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.
‘allan Organized Came (iOC), Russian/Eastern European, Caribbean, or Nigeran Organized Crime Group -
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.
BIE- MH - [08062 - 200
HOUSE_OVERSIGHT_021620