: 12-19-08)
quad supervisor approval please initial)
File Number
Drugs oO A Fugitive Oo Bankruptcy Fraud O Computer Fraud/Abuse O
Corruption of Public Official 1 Money Laundering Sub Invest Asst by FO(s)
Asst. FO(s) A BC. DL
A. Complaint / information/ Indictment
(Federal [Local Complaint Date:
(7 International
Check if Civil Rico Complaint 1 information Date:
indictment Date:
B, Locate / Arrest (Federal [Local [7 International - Subject Priority, OA (1B Oc Locate Date: Arrest Date: CO Subject Resisted Arrest (7) Subject Arrested was Armed
Cc. Summons Date: (Federal [[] Locat
D, Recovery / Restitution / PELP X (Federal [JLocal [£] International Recovery Date: Code * vy Amount $ Code ° ¥ Amount $ Restitution Date: ————— (1) Court Ordered {([} Pretrial Diversion
Code*__ vy =Amount $
PELP Date:
Code * v“ Amount $
&. Hostages(s) Released Date: Released by: [1] Terrorist (F) Other
Number of Hostages;
P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, L and N
ee a ee
Subject related to an LCNfAsian Organized Crime (AOC), Nalian Organized Crime (IOC), Russlan/Eastern European, Caribbean, or Nigenan Organized Crime Group =
Fort
Complete FD-5153, Side 1 Blocks A-E mandatory, F-H as appropriate.
Accomplishment Report Date Prepared 2d Q 4 b6 (Accomplishment must be reported and loaded into Date Loaded Os ISRAA within 30 days from date of accomplishment) Date Loader’s Initials b7¢c
b7E
Investigative Assistance or Technique Used 4. 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
IAT Rate FO AT Rate FO {AT Rate FO [FinAnayst | MM icp.riete suo | | [uco-natwact| | Pio cover |__| exsur/Fisc | | ‘| search Warant isis Nop.-Looal| | ELSUR/T. Ill ERTAsst. |_| | Jsosass. | Evid, Purchase | [uoo-crovpt | [Foc anoasst |__| fiat. om eam) | _[vco-crovpit] — famgNonrartabex| |_|
J. Civil Rico Matters Date: Also complete “Section G”
Other Clvil Matters Date:
IAT
ler | Pd
BB Butte - ITC Sav-ITC |_|
Beos-no |_|
F, Conviction (ClFederal [Local
Conviction Date:
(7 Intemational!
Judgment___.__.____® Judicial Outcome
Subject Description Code a
“x For 6F, G, H-Include Agency Code
(Felony
(1 Plea State:
Amount $
or Misdemeanor . O Suspension: Years
or C Triat Judicial District:
Months______.
K. Administrative Sanction Date: Subject Description Code Type: Length: Suspension {[] Permanent Debarment ie) Injunction Year. L. Asset Seizure Date:. Asset Forfeiture Date: CATS # Mandatory
Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal
G, U.S. Code Violation Required for sections A, B, F and J (Federal Only)
r Title Months
Section # Counts
Do not indicate $ value in Section D
H. Sentence Date:
Sentence Type: M. Acquittal/ Dismissal/ Pretrial Diversion
(Circle one) Date: Years______... Months
Months Months____
In Jail:
Suspended: Years N. Drug Seizures “Date:
Years, $
Probation: Drug Code ®
Weight FDIN Do not indicate $ in Section D
Fines: Code *
1. Disruption/Dismantiement: “
O. Child Victim Information Child located / identified Date:
Prriving
Disruption Date:
(Cj Deceased
Dismantlement Date:
Completion of FD-515a Side 2 Mandatory
b6
Social Security No. (if available) bic
Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy targel group, or a VCMO Program National Priority Initiative largel group -
Complata FD-515a, Sida 1 Blocks A-C only.
x Additional information may be added by attaching another form or a plain sheet of paper for additional entries.
« See codes on reverse side.
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.
B/lE- MH - (0 &062- 207
HOUSE_OVERSIGHT_ 021634