HOUSE_OVERSIGHT_021596.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
1. [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 including: 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: [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
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
[Checked] Living [Unchecked] 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]
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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-108062-188
HOUSE_OVERSIGHT_021596