HOUSE_OVERSIGHT_021622

FD-515 (Rev. 12-19-06) 6 Accomplishment Report Date Prepared

quad 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 1. 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 Rate FO AT Rate FO (AT

Rate FO —sIAT.-—«<s=—séRale FO. sIAT | rin anayst [tcp rewsup || [uco-nateack] IR victwitn coor PenRegisters | JMENcavorvicap| NII 10 Wanted Fiyer

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A. Complaint / information/ indictment F, Conviction J. Civil Rico Matters Date:

[tab.ov.exam| | [uco-croup i] | ClFederat [CJLocat (J Intemational (Federal [Local [7] Intemational Also complete “Section G"

Complaint Date: Conviction Dates Other Civil Matters Date:

Accomplishment involves: (check all that apply)

File Number

O O Bankruptcy Fraud oO Computer Fraud/Abuse Oo Corruption of Public Official C1

Check if Civil Rico Complaint Subject Description Code *(——_)* MOQMOT ates Judicial Outcome. x

Amount $

Suspension: Years Months

Information Date: For 6F, G, H-Include Agency Code

indictment Date: [Felony or [1] Misdemeanor (Plea or 0 Trial ; B, Locate / Arrest State:_______._ Judicial District: ___ K. Administrative Sanction Date:

(CiFederal ([JLoca! [] international: oe Subject Description Code

; . G. U.S. Code Violation Type: Length:

Subject Priority: JA 4B 1c Required for sections A, B, F and J a ‘ Suspension [[] Permanent i: Debarment oO

Locate Date: (Federal Only) r Injunction Year Months

Arrest Date: Title Section # Counts

(2 Subject Resisted Arrest mm ---_ —_ L. Asset Seizure Date:

(J Subject Arrested was Armed Asset Forfeiture Date: ——__ __ TT CATS # Mandatory

Cc, Summons Date: Circle below one of the three asset forfeiture: (Federat [7] Local Admin, Civil Judicial, or Criminal

Do not indicate $ value in Section D D, Recovery / Restitution / PELP X

[]Federal [Local [1 International H. Sentence Date: Recovery Date: Sentence Type: '

* Circle one) Date: Gade ° y Amount § ‘In Jail; Years____.. Months. ( ) Code*_ oY ~=Amount $

Restitution Date: (1 Court Ordered = [[] Pretrial Diversion Probation: = Years_____. Months____ Drug Code ® ; Code*_ sv) Amount $ Fines: i Weight ________. Code PELP Date: gus

———_—_—_—_— ‘ Do not indicate $ in Section D Code * ¥ Amount $e 1. Disruption/Dismantlement: ~

E. Hostages(s) Released Date:___...___ . . O. Child Victim Information

. Disruption Date:

Released by: [J Terrorist []) Other Child located /identified Date: O&/goO of Dismantiement Date:

Number of Hostages: Phivi ° D d 5 Completion of FD-515a Side 2 Mandatory =e - [)Decease

M. Acquittal/ Dismissal/ Pretrial Diversion

. Suspended; Years__._.— Months.._ N. Drug Seizures Y Date:

P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, !, Land N

Subject related to an LCN, Asian Organized Crime (AOC), italian Organized Cnme (IOC), Russian/Eastern European, Caribbean, or Nigerian Organized Came Group - Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate,

| Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy target group, or a VCMO Program Nalional Priority Initialive target group + Complate FD-615a, 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. Ba NET RD AIS e See codes on reverse side. |

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.

B/E-Nn- 108062-29]

HOUSE_OVERSIGHT_021622