HOUSE_OVERSIGHT_021586.jpg

FD-515 (Rev. 12-19-06)
[Redacted Box] Squad supervisor approval (please initial)
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)
Asst. FO(s)
A. B. C. D.
Task Force

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:

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 Investigative Techniques - The box for 'Vict-Witn Coor' (Victim-Witness Coordinator) appears to be marked/blacked out]
Fin. Analyst, Lab. Field Sup, UCO - Nat. Back, Vict-Witn Coor
Aircraft Asst., Pen Registers, NCAVC/ Vi-CAP, IO Wanted Flyer
Computer, Photo Cover, Crim/NS Intel Asst, SARs
Consen Mon., Polygraph, Crisis Neg.- Fed, CART
ELSUR / FISC, Search Warrant, Crisis Neg.- Local, Asset Forf Prog
ELSUR / T. III, Show Money, ERT Asst., Forf Support Proj
Eng. Field Spt., SOG Asst., Butte - ITC, TFOS/CTD
Eng. Tape Ex., Swat Team, Sav - ITC, CXS/CTD
Legats Asst., Tech. Ag/Equip., Poc - ITC, InfraGard/CyD
Evid. Purchase, Phone Toll Rec, Ft. Mon. - ITC, OFC/CID
Lab. Div. Exam, UCO - Group I, For. Lang Asst., PPP
UCO - Group II, Non FBI Lab Ex

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 _____ • 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 √ 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)

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-108062-183
HOUSE_OVERSIGHT_021586
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