House Oversight FD-515 Accomplishment Report Form (generic investigative checklist)

FD-515 (Rev, 12-19-06) * Accomplishment Report e Date Prepared 29/08 ‘Squad supervisor approval (Accomplishment must be reported and loaded into ‘ Date Loaded (please initial) ISRAA within 30 days from date of accomplishment) Date Loader's Initials Investigative Assistance or Technique Used "O62! 2. Helped, minimally 4, Absolutely essential Drugs [S/ e For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO IAT IAT [Finwanaiyst |_| | Aicrattasst. | | | Pen Registers Computer | |Phoiocover | | fetsurrrisc| | [search Warrant) Teisunt.it | lll stow voney |_| fero.Fiese| | [socass. |_| Brrosicm EE Em Sc Bosco | [Legos Asst, | [ME Tech tec.) [MPoc- mo |_| | = O A Fugitive 0 Bankruptcy Fraud O Computer Fraud/Abuse C] Corruption of Public Official Money Laundering Sub Invest Asst by FO(s) Rate FO Rate FO Rate FO tA Rate FO aT ° [| Jco-naiooal Bxcwervicer| — fil B cin mass] | issn ea] | - InfraGard/CyD Evid. Purchaso| [MM Phone Toll Rec| — [MNNFL.Mon.-1tc | NN OFCICID invowinfo | | [uco-Group! | [MME For LangAsst. |_| free | fist ov. am] | uco-crupit] fvenemitavex] | | | J. Civil Rico Matters Date: Also complete "Section G” Other Civil Matters Date: F, Conviction (Federal ([Jkocal [7 Intemational Conviction Date: A. Complaint / Information/ indictment (JFederat [Jkocal [1] Intemational Complaint Date: Check if Civil Rico Complaint O Subject Description Code *(__* SET aes aa For 6E G, HeInclude A Bud Judicial Outcome__._-_ OX Information Date: or Or, G, M-Incluae Agency Co ° Amount $ Indictment Date: [1 Felony or [J Misdemeanor Suspension: Years Months__ (Plea or 0 Trial B. Locate /Arrest State: Judicial District: [Federal [JLocat [7 International - Subject Priority: TIA 8 (Oc K. Administrative Sanction Date: Subject Description Code . Type: Length: G. U.S. Code Violation Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Only) Debarment or Arrest Date: Title Section # Counts Injunction Year, Months (_] Subject Resisted Arrest (1D Subject Arrested was Armed L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory EEE Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal Cc. Summons Date: (Federal [[] Local D. Recovery / Restitution / PELP X (0 Federal D)Local [7] International Recovery Date: Code * vy Amount $ Code*__ sv = Amount $ Restitution Date: Do not indicate $ value in Section D H. Sentence Date: Sentence Type: . M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: Months___ Months___ In Jail: Years. Suspended: Years N. Drug Seizures Vv Date: (Court Ordered {[] Pretrial Diversion Probation: Years Months____. Drug Code * Code*___sy = Amount $ Fines: $ . eo aie PELP Date: y Do not indicate $ in Section D Code * Y Amount $ |, Disruption/Dismantlement: “ . E. Hostages(s) Released Date: . Disruption Date: Released by: (J Terrorist (7) Other 0. Child Victim Information Child located / identified Date:_O off oproy Dismantlement Date: Phriving _ (Deceased Number of Hostages: Completion of FD-515a Side 2 Mandatory P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, Land N (a a a cee eee eee es ee Ol Subject related to an LCN, Asian Organized Crime (AOC}, italian Organized Cnme (1OC), Russian/Easiern European, Caribbean, or Nigerian Organized Crime Group - Complete FD-5152, Side 1 Blocks A-E mandatory, F-H as appropriate, oO Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targot group, or a VCMO Program Nallonal Priority Initlalive target group - Complete FD-515a, Sida 1 Blocks A-C only. x. Additional information may be added by attaching another form or a plain sheet of paper for additional entries. Serial Mo; OLFD-516 e See codes on reverse side. L —C—sSYO ¥ 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. BIE-MM - (08062-2049 & be b7C bTE b6 b7Cc HOUSE_OVERSIGHT_021638