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FD-515 (Rev. 12-19-06)
Squad supervisor approval (please initial) [Blank Box]

Accomplishment Report
(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)

Date Prepared 09/29/08
Date Loaded 9/30/08
Date Loader's Initials [REDACTED]
[Redaction Codes: b6, b7C, b7E]

Accomplishment involves: (check all that apply)
Drugs [ ]
A Fugitive [ ]
Bankruptcy Fraud [ ]
Computer Fraud/Abuse [ ]
Corruption of Public Official [ ]
Money Laundering [ ]
Sub Invest Asst by FO(s) [ ]

File Number: 31E-MM-108062

Stat Agent Soc Sec No [REDACTED]
Stat Agent Name [REDACTED]

RA: PBCRA
Squad: PB-2

Assisting Agents Soc. Sec. No. [REDACTED]
1. Name [REDACTED]
2. Name [REDACTED]

Asst. FO(s) A. B. C. D. [Blank]
Task Force [Blank]

Investigative Assistance or Technique Used
1. Used, but did not help
2. Helped, minimally
3. Helped, substantially
4. Absolutely essential
For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO
[Table of techniques listed: Fin. Analyst, Aircraft Asst., Computer, Consen Mon., ELSUR / FISC, ELSUR / T. III, Eng. Field Spt., Eng. Tape Ex., Legats Asst., Evid. Purchase, Inf/CW Info, Lab. Div. Exam, Lab. Field Sup, Pen Registers, Photo Cover, Polygraph, Search Warrant, Show Money, SOG Asst., Swat Team, Tech. Ag/Equip., Phone Toll Rec, UCO - Group I, UCO - Group II, UCO - Nat.Back, NCAVC / Vi-CAP, Crim/NS Intel Asst, Crisis Neg.- Fed, Crisis Neg.- Local, ERT Asst., Butte - ITC, Sav - ITC, Poc - ITC, Ft. Mon. - ITC, For. Lang Asst., Non FBI Lab Ex, Vict-Witn Coor, IO Wanted Flyer, SARs, CART, Asset Forf Prog, Forf Support Proj, TFOS/CTD, CXS/CTD, InfraGard/CyD, OFC/CID, PPP]
[No boxes checked in table]

A. Complaint / Information/ Indictment
[ ] Federal [ ] Local [ ] International
Complaint Date: ____
Check if Civil Rico Complaint [ ]
Information Date: ____
Indictment Date: ____

B. Locate / Arrest
[ ] Federal [ ] Local [ ] International
Subject Priority: [ ] A [ ] B [ ] C
Locate Date: ____
Arrest Date: ____
[ ] Subject Resisted Arrest
[ ] Subject Arrested was Armed

C. Summons Date: ____
[ ] Federal [ ] Local

D. Recovery / Restitution / PELP X
[ ] Federal [ ] Local [ ] International
Recovery Date: ____
Code * ____ Amount $ ____
Code * ____ Amount $ ____
Restitution Date: ____
[ ] Court Ordered [ ] Pretrial Diversion
Code * ____ Amount $ ____
PELP Date: ____
Code * ____ Amount $ ____

E. Hostages(s) Released Date: ____
Released by: [ ] Terrorist [ ] Other
Number of Hostages: ____

F. Conviction
[ ] Federal [ ] Local [ ] International
Conviction Date: ____
Subject Description Code * (____) *
For 6F, G, H-Include Agency Code
[ ] Felony or [ ] Misdemeanor
[ ] Plea or [ ] Trial
State: ____ Judicial District: ____

G. U.S. Code Violation
Required for sections A, B, F and J (Federal Only)
Title Section # Counts
____ ____ ____
____ ____ ____
____ ____ ____

H. Sentence Date: ____
Sentence Type: ____
In Jail: Years ____ Months ____
Suspended: Years ____ Months ____
Probation: Years ____ Months ____
Fines: $ ____

I. Disruption/Dismantlement: [Checkmark]
Disruption Date: ____
Dismantlement Date: ____
Completion of FD-515a Side 2 Mandatory

J. Civil Rico Matters Date: ____
Also complete "Section G"
Other Civil Matters Date: ____
Judgment ____
Judicial Outcome ____
Amount $ ____
Suspension: Years ____ Months ____

K. Administrative Sanction Date: ____
Subject Description Code ____
Type: Length:
[ ] Suspension [ ] Permanent
[ ] Debarment or
[ ] Injunction Year ____ Months ____

L. Asset Seizure Date: ____
Asset Forfeiture Date: ____
CATS # Mandatory ____
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: ____

N. Drug Seizures [Checkmark] Date: ____
Drug Code * ____
Weight ____ Code * ____
FDIN ____
Do not indicate $ in Section D

O. Child Victim Information
Child located / identified Date: 06/30/2008
[X] Living [ ] Deceased

P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, L and N
Name [REDACTED]
Race * [REDACTED]
Sex [REDACTED]
Date of Birth [REDACTED]
Social Security No. (if available) [REDACTED]
[Redaction Codes: b6, b7C]

For Indictments/Convictions only.
[ ] Subject related to an LCN, Asian Organized Crime (AOC), Italian Organized Crime (IOC), Russian/Eastern European, Caribbean, or Nigerian Organized Crime 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 Strategy target group, or a VCMO Program National Priority Initiative target 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.
* See codes on reverse side.
[Checkmark] 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.

Serial No. of FD-515 [Blank]

31E-MM-108062-208

HOUSE_OVERSIGHT_021636