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FD-515 (Rev. 12-19-06)

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

Squad supervisor approval (please initial) [REDACTED]

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
Assisting Agents Soc. Sec. No. [REDACTED]
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. Assist. by other FO(s) indicate A, B, C, D for corresponding FO

Rate FO | IAT | Rate FO | IAT | Rate FO | IAT | Rate FO | IAT
[Grid of abbreviations follows:]
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
Inf/CW Info | UCO - Group I | For. Lang Asst. | PPP
Lab. Div. Exam | 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
[REDACTED TABLE]
Race * [REDACTED] Sex [REDACTED] Date of Birth [REDACTED] Social Security No. (if available) [REDACTED]

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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-108062-192
HOUSE_OVERSIGHT_021604