House Oversight Form with Generic Investigation Checklist

) Date Prepared if Z (please initial) ISRAA within 30 days from date of accomplishment) 5 Vv. 12-19-06) @ Accomplishment Report ‘Squad supervisor approval (Accomplishment must be reported and loaded into ; Date Loaded Date Loader’s Initials Investigative Assistance or Technique Used eee aot File Number 4. Used, but did not help 3. Helped, substantially , E-MM—- jf afoez 2. Helped, minimally 4. Absolutely essential For Sub, Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Rate FO laT Rate FO IAT Rate FO 1A [Fin aneiyst | Piva rietasun | | Frecetaesc | | [Pores | cepa || eos 1 PL corsenitn | ce oe SO Score |__| socasst. HB Butte - TC Bswattoom | TM saverc | Bankruptcy Fraud Computer Fraud/Abuse C Corruption of Public Official (0 Money Laundering O Sub Invest Asst by FO(s) Rate FO IAT . juco-NatBeck| NCAVCY Vi-CAP ; coin intl Asst] | . CART HevstsNog-tocal| | RA A.B. OC, De Evid. Purchase Phone Toll Rec Ft.Mon.-1TC | [iN OFCICID Inf(CW Info UGCO - Group | For. Lang Asst. | | jprp | Lab, Div, Exam UCO - Group II NonFBitabex} | fo | J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: F. Conviction (Federal Di Local Conviction Date: A. Complaint / Information/ indictment (}Federat [Local [7 International Complaint Date: (2 Intemational! Check if Civil Rico Comptaint. (1 Subject Description Code *(__)» Judgment — —— na” ; For 6, G, Heinclude A Bnd Judicial Outcome. _ OX Information Date: or OF, G, H-Inciude Agency Cade Amount $ indictment Date: 5 Palony or 5 al Suspension: Years Months Plea or Tria B. Locate / Arrest State: Judicial District: (Federal [local [International - Subject Priority: TTA CIB [1c K. Administrative Sanction Date: Subject Description Code a 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. (i Subject Resisted Arrest [ Subject Arrested was Armed L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory —_____9/»_ ____ Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal Cc. Summons Date: (Federal (7 Local . Recovery / Restitution / PELP X []Federal [JLocal [J International Recovery Date: Code * v Amount $ Code*__sy Amount $ Restitution Date: Do not indicate $ vatue 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 “ Date: (Court Ordered 1] Pretrial Diversion Probation: Years, Months_____ Drug Code ° “ Code * v Amount $ Fines: $ a Code PELP Date: i Do not indicate $ in Section D Code* ov =Amount $ |. Disruption/Dismantlement: . Hostages(s) Released Date: Disruption Date: 0. Child Victim Information Released by: CTerrorist [7] Other Child located / identified Date: by 29 OY Btiving _ (Deceased Dismantlement Date: Number of Hostages: Completion of FD-515a Side 2 Mandatory P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks &, |, L and N ee ees es ee ee ly: visdOns 0: . 0 Subject related fo an LCN, Asian Organized Crime (AOC), Ilalian Organized Crime (IOC), Russian/Eastern European, Caribbean, or Nigerian Organizad Cnme Group - Completa FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate, oO Subject ralatad to an OC/Drug organization, a VCMO Program National Gang Strategy targa! group, or a VCMO Program National Priority Initiative targel group « Completa 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. erie) NG BLE S15 e See codes on reverse side. PE ¥ 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. AlE-NY -—]06062- | 78 b6 b7C b7E b6 b7Cc HOUSE_OVERSIGHT_021576