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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]
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

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

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

[Table of Techniques - Middle section heavily redacted with black blocks]
Rate FO | IAT
[REDACTED columns]

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 $ ______
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: [X]
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 Block 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.
[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
31E-MM-108062-209

HOUSE_OVERSIGHT_021638