HOUSE_OVERSIGHT_021628.jpg

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

Asst. FO(s) A. _ B. _ C. _ D. _
Task Force
Assisting Agents Soc. Sec. No. X [Redacted]
Name [Redacted]
2. [Redacted]
Name: [Redacted]

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
[Grid 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]

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: [ ]
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 [ ] 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]

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.
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
31E-MM-108062-204
HOUSE_OVERSIGHT_021628
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