HOUSE_OVERSIGHT_021624

‘ * | FD-515 (Rev. 12-19-06) ®@ Accomplishment Report ° Date Prepared 29/0 S

Squad supervisor approval (Accomplishment must be reported and loaded into Date Loaded 20/ O¢ (please initial) ISRAA within 30 days from date of accomplishment) Date Loaders Initials

Investigative Assistance or Technique Used

File Number 1. Used, but did not help 3. Helped, substantially — PPIy, 5 S/E-MMn—[ow Oez| 2. Helped, minimally 4, Absolutely eesenial — al For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Banieuptey Fraud ol | Rate FO aT Rata FO IAT Rate FO \AT Rata FO 1aT b6 Computer Fraud/Abuse | Fin anaiyst | bab riettsun |] [uco-narpack{ | b7C Corruption of Public Offctal BR Aicconasst | | [Penensore | —_ fli oaver ican] | aE [Consen won. | [I Potyoraph | ME crisis Neg. Fed] | RA Squad] AFOOT | PRCA Re fevsuririsc || [search Warant| Mss top-Locl| | LEED Pause tu | A Siow vonoy | JMenracs, |_|

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Sav - ITC Poc- ITC

Ft. Mon. - ITC

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J. Civil Rico Matters Date: Also complete “Section G"

Other Civil Matters Date:

F. Conviction (Federal ([JLocalt [7] Intemational Conviction Date:

A. Complaint / Information/ indictment

(JFederat [Local {J International Complaint Date;

Check If Civil Rico Complaint 1 Subject Description Code *(—_)* Judgment ——._——_—__.___* Judicial Outcome —*% Information Date: For 6F, G, H-Include Agency Code Amount $ Indictment Date: 5 Petty or 5 aad Suspension: Years Months__ Plea or ria B, Locate / Arrest State: Judicial District: K. Administrative Sanction Date:

Subject Description Code . Type: Length:

(Federal [JLocal [[] International : Subject Priority, OA 4B Oc

G, U.S. Code Violation

Required for sections A, B, F and J Suspension [] Permanent Locate Date: (Federal Only) A Debarment or Arrest Date: Title Section # Counts Injunction Year. Months.

(1 Subject Resisted Arrest (3 Subject Arrested was Armed

L. Asset Seizure Date:. Asset Forfaiture Date: CATS # Mandatory Circle below one of the three asset forfeiture:

Admin, Civil Judicial, or Criminal

. Summons Date: (Federal [j Locat

. Recovery / Restitution / PELP X (Federal [Local [1 international Recovery Date:

Code * v Amount $ Code*__syv = Amount §

Restitution Date:

Do not indicate $ value in Section D

H, Sentence Date: - M. Acquittal/ Dismissal/ Pretrial Diversion

Sentence Type: *

(Circle one) Date:

Months____ Months.

In Jail: Years,

Suspended: Years

N. Drug Seizures V Date:

(Court Ordered [[] Pretrial Diversion Probation: Years Months___ Drug Code * Code * ¥ Amount $ Fines: $ <a Code PELP Date: é Do nat indicate $ in Section D Code * v Amount $ |. Disruptlon/Dismantlement: Vv

E. Hostages(s) Released Date:,

Disruption Date:

Released by: [1] Terrorist [[] Other

O. Child Victim Information Child located / identified Date: oof opray

PRuiving _ [Deceased

Dismantlement Date:

Number of Hostages: Completion of FD-515a Side 2 Mandatory

P, Subject Information - Required for ail blocks excluding block D (Recovery/PELP), blocks E, 1, Land N b6 | | | Race* | Sex | Date of Birth Social Security No. (if available) b7c

oO Subject related to an LCN, Asian Organized Crime (AOC), italian Organized Crime (!0C), Russian/Easlern European, Caribbean, or Nigerian Organized Came Group + Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate,

oO Subject related to an OC/Drug organizalion, a VCMO Program National Gang Strategy target group, or a VCMO Program Nalional Priority Initiative target group - Complata 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,

Serial No. of FD-515 e See codes on reverse side. [|

Y 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.

O/E-MW - '!98062- 2o2

~ HOUSE_OVERSIGHT_021624