Accomplishment Report Date Prepared
(Accomplishment must be reported and loaded into . Date Loaded ISRAA within 30 days from date of accomplishment) Date Loader’s Initials
Investigative Assistance or Technique Used
1, Used, but did not hetp 3. Helped, substantially \s/€-MM1- 168 C62! 2. Helped, minimally 4. Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO
IAT [ren esses | Il cavcrvicae| —_ al So ore ss Fo ra
Computer Fraud/Abuse Corruption of Public Official [1 Money Laundering
Sub Invest Asst by FO(s)
[Fait |_| ics
Polygraph can [crisis Neg-Fed)__| search werent] (ME Heo-Loea| | | Fsocass | [mewto-ro |_| IB ech. Antu, froo-rro | Fi ton.-1o || [tat Gi.cxam| | _[uco-coupn| mNenraitabex| |_|
J. Civil Rico Matters Date: Also complete "Section G"
Other Civil Matters Date:
Assat Forf Prag
:
Rate FO IAT Rate FO
F. Conviction (]Federal [JLocal [[] Intemational Conviction Date:
A. Complaint / information/ indictment
[JFederal ([JLocat {International Complaint Date:
Check if Civil Rico Complaint O Subject Description Code *(——)* eigen ° Judicial Outcome. OX Information Date: For 6F, G, H-Include Agency Gane Amount $ Indictment Date: = id or 5 na Suspension: Years Months. Plea or Trial
B. Locate / Arrest State: Judicial District: K. Administrative Sanction Date:
[Federal [Local [J International - . Subject Description Code ; | G, U.S, Code Violation Type: Length: Subject Priority: OA OB (1c Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Only) Debarment or Arrest Date: Titte Section # Counts Injunction Year. Months
(] Subject Resisted Arrest (1 Subject Arrested was Armed
L. Asset Seizure Date:. Asset Forfeiture Date: CATS # Mandatory
Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal
C. Summons Date: (Federal ([) Local
. Recovery / Restitution / PELP X (0 Federal DJLocal [J International Recovery Date:
Code * v Amount $
Code ° ¥ Amount $
Restitution Date:
Do not indicate $ value in Section D
H. Sentence Date:
Sentence Type: . M. Acquittal/ Dismissal/ Pretrial Diversion
t '
(Circle one) Date:
In Jail: Years, Months.
Suspended: Years_____. Months_____m_ N. Drug Seizures Y Date:
(Court Ordered [J Pretrial Diversion Probation: Years, Months__. Drug Code ® : Code * yY Amount $ Fines: $ ro Code BEL PDAS . Do nat indicate $ in Section D Code*__ v= Amount $ |, Disruption/Dismantlement: ¥
m
. Hostages(s) Released Date:
: Disruption Date: Released by: [] Terrorist (J) Other
0. Child Victim Information Child located /identified Date:_O of opey
Prriving (7) 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, I, Land N | a 7 | Race | sex | __ fateofsitn Social Security No. (if available) a a ee eee
Fort
Subject¥6lated to an LCN, Asian OrgantzeqCrime (AOC), Italtan Organized Cnme (IOC), Russian/Eastern European, Caribbean, or Nigerian Organized Crime Group - Complete FD-515a, Side 1 Blocks A-E magdatory, F-H as appropriate,
Subject related to an OC/Drug organizatoh, a VCMO Program Nalionat Gang Strategy target group, or a VCMO Program Nationat Priority Initiative targel group - Complete 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. petal Nout FD-918
e See codes on reverse side, |_ s—sisiszr
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.
8/E-MU- [08062 - 2a
be b7C
HOUSE_OVERSIGHT_021630