HOUSE_OVERSIGHT_021592.jpg

FD-515 (Rev. 12-19-06)
Squad supervisor approval (please initial) [REDACTED BOX]
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]
[Margin Codes]: 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. [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
[Grid of technical/investigative options including Fin. Analyst, Aircraft Asst, Computer, Consen Mon, ELSUR/FISC, Search Warrant, Show Money, SWAT Team, Tech Ag/Equip, Phone Toll Rec, UCO - Group I/II, NCAVC/Vi-CAP, Crim/NS Intel Asst, Crisis Neg. - Fed, 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: /
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 * [REDACTED]
Sex [REDACTED]
Date of Birth [REDACTED]
Social Security No. (if available) [REDACTED]

[Bottom Fine Print]
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 [Blank]
31E-MM-108062 - 186
HOUSE_OVERSIGHT_021592