HOUSE_OVERSIGHT_021616.jpg

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)

Date Prepared 09/29/08
Date Loaded 9/30/08
Date Loader's Initials [Redacted]

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]
Task Force

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 listing Rate FO and IAT columns includes: 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., Bulle - 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]

[Several boxes in the grid appear redacted or marked with black blocks, specifically in the Computer and Financial Analyst rows, though exact selection is obscured by black redaction blocks]

Name [Redacted]
2. [Redacted]
Name: [Redacted]

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 _____
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
[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.
/ 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-108062-198
HOUSE_OVERSIGHT_021616

[Margin codes: b6, b7C, b7E]