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FD-515 (Rev. 12-19-06)
Accomplishment Report
Squad supervisor approval (please initial)
(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]
[Redaction Codes Margin: 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.
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 - Rate FO / IAT]
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-Wtn Coor
IO Wanted Flyer
SARs
CART
Asset Forf Prog
Forf Support Proj
TFOS/CTD
CXS/CTD
InfraGard/CyD
OFC/CID
PPP

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

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 * ______ Check Amount $ ______
Code * ______ Check Amount $ ______
Restitution Date: ______
[ ] Court Ordered [ ] Pretrial Diversion
Code * ______ Check Amount $ ______
PELP Date: ______
Code * ______ Check Amount $ ______

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: Check
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:
[ ] Suspension
[ ] Debarment
[ ] Injunction
Length:
[ ] Permanent or 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 Check Date: ______
Drug Code * ______
Weight ______ Code * ______
FDIN ______
Do not indicate $ in Section D

E. Hostages(s) Released Date: ______
Released by: [ ] Terrorist [ ] Other
Number of Hostages: ______

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
[Redacted Name Block]
Race * [Redacted] Sex [Redacted] Date of Birth [Redacted] Social Security No. (if available) [Redacted]
[ ] 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.
Check 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-108062-200
HOUSE_OVERSIGHT_021620