HOUSE_OVERSIGHT_021590.jpg

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]

[Right 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. [Blank]
Stat Agent Name [Blank]
RA: PBCRA
Squad: PB-2

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 - mostly unchecked except potentially 'Vict-Witn Coor' which appears filled/blacked out]
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, FL Mon. - ITC, OFC/CID
Inf/CW Info, UCO - Group I, For. Lang Asst., PPP
Lab. Div. Exam, UCO - Group II, Non FBI Lab Ex

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
[Redacted Box for Name] Sex [Blank] Date of Birth [Blank] Social Security No. (if available) [Blank]

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.

31E-MM-108062-185
HOUSE_OVERSIGHT_021590
[Right Margin Codes: b6, b7C]