HOUSE_OVERSIGHT_021624.jpg

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

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 Box]

Stat Agent Name
[Redacted Box]

RA: PBCRA
Squad: PB-2

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

Assisting Agents Soc. Sec. No. x
[Redacted Box]

Name
2. [Redacted]
Name: [Redacted]

Investigative Assistance or Technique Used
1. Used, but did not help
3. Helped, substantially
2. Helped, minimally
4. Absolutely essential
For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO

[Grid of techniques listed with Rate FO columns - mostly unchecked]
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., Butte - 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

[Right Margin Codes: b6, b7C, b7E]

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 $ _______

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

[Right Margin Codes: b6, b7C]

For
[ ] 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 - 202
HOUSE_OVERSIGHT_021624