HOUSE_OVERSIGHT_021610.jpg

FD-515 (Rev. 12-19-06)
Squad supervisor approval (please initial) [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]
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

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

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

[Table Headers: Rate FO, IAT]
[Table Content]
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: [Checked]
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

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
[Redacted] Race*
[Redacted] Sex
[Redacted] Date of Birth
[Redacted] Social Security No. (if available)

For [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
3/E-MM-108062-195
HOUSE_OVERSIGHT_021610
b6
b7C