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FD-515 (Rev. 12-19-06)
Accomplishment Report
Date Prepared 09/29/08
Squad supervisor approval (please initial)
(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)
Date Loaded 9/30/08
Date Loader's Initials [REDACTED]
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. x

Name [REDACTED]
2. [REDACTED]
Name: [REDACTED]

Investigative Assistance or Technique Used
1. Used, but did not help
3. Helped, substantially
2. Helped, minimally
4. Absolutely essential
For Sub. Invest. Asst. by other FO(s) indicate A, B, C, D for corresponding FO

[Table of Techniques - mostly unchecked]
Rate FO | IAT | Rate FO | IAT | Rate FO | IAT | Rate FO | IAT
... [List includes Fin. Analyst, Aircraft Asst., Polygraph, Search Warrant, Pen Registers, etc.] ...

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 ____________ *x
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: 6/30/08
[X] Living
[ ] Deceased

P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, L and N
Name [REDACTED]
Race *
Sex
Date of Birth
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.
[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.

31E-MM-108062-178
HOUSE_OVERSIGHT_021576