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FD-515 (Rev. 12-19-06) Accomplishment Report
Squad supervisor approval (please initial) [REDACTED]
(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)
Date Prepared 09/29/08
Date Loaded 9/29/08
Date Loader's Initials [REDACTED]
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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) [ ]

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

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. [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
[Grid of techniques listed: 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: /
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 NAME BLOCK]
Race * [REDACTED]
Sex [REDACTED]
/ Date of Birth [REDACTED]
Social Security No. (if available) [REDACTED]

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.

Serial No. of FD-515 31E-MM-108062-184
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.

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HOUSE_OVERSIGHT_021588