House Oversight Form FD-515 – Generic Reporting Template with No Specific Allegations

D-515 (Rev. 12-1 9-06) © Accomplishment Report | Date Prepared exfal. 1/29] o€ “Squad supervisor approval (Accomplishment must be reported and loaded into . Date Loaded GY = So — OS- (please initial) ISRAA within 30 days from date of accomplishment) Date Loader’s Initials investigative Assistance or Technique Used File Number 1, Used, but did not help 3. Helped, substantially o Ec -MM-{oKoez 2. Helped, minimally 4, Absolutely essential o For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Bankruptcy Fraud oO ST Rate FO aT Rate FO IAT Rate FO IAT Rate FO IAT b6 Computer FraudAbuse CI oe oc BIC Corruption of Public Orca OO | J AircrattAss. | | | Pen Registers | fRMMIENCAVC/ V-CAP 10 Wanted Flyer b7 dare Bccimmis nit fos| MMSARS . Sub Invest Asst by FO(s) —_—OS [ [concen tan sis Nea. Fel | Raat FOR) yfecsunreisc | | [sean werent) fl oisieneo-toca] fi A.B. G._D. | Jecsurst.m | [i showmonsy | Bert Acc, | [IMM Fort Support Pro a So | cae [Legats Asst | [MM Tech. agiécuip.| [MMB Poo-trc | I infraGarcioyo | [ Evid. Purchase| | BFt.Mon.-1tc | JM OFC/cIO —[mvcwinio || _[uco-croupi | QM Foctenadsst | liver | [tab.owexam| | [uco-rouo | JNonrsttebex] | | A. Complaint / Information! Indictment F. Conviction J. Civil Rico Matters Date: ClFederat [Local [International (iFederal [Local [7] Intemational Also complete “Section G” Complaint Date:__ Conviction Date Other Civil Matters Date: . oes es Check if Civil Rico Complaint O01 Subject Description Code *(—___)* Judgment a ee mee For GF, G, Henclude A Cod Judicial Outcome OX : or 6F, G, H-Include Agency Code Information Date: __ nae Amount $ Indictment Date: L) Felony of ( Misdemeanor Suspension: Years Months (Plea or 0 Trial . Locate / Arrest State:_____._ Judicial District; ____ K. Administrative Sanction Date: C)Federat [Local [International - , Subject Description Code ; . G. U.S. Cade Violation Type: Length: Subject Priority: OA OB O¢ Required for sections A, B, F and J ‘ ' Suspension _["] Permanent Locate Date: (Federal Only) A Debarment or Arrest Date: Title Section # Counts Injunction Year Months (-] Subject Resisted Arrest eto ciaaael —— L. Asset Seizure Date: LO Subject Arrested was Armed Asset Forfeiture Date: ~ a CATS # Mandatory __ . Summons Date: Circle below one of the three asset forfeiture: (]Federat [J Local . Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D . Recovery / Restitution / PELP X H,.Sent tial of lndizate oy aoa aii CiFederal [JLoca! [J International psentence:Mate; ; Recevany Data: Sentence Type: ; M. Acquittal/ Dismissal/ Pretrial Diversion ° (Circle one) Date: cere v Amount $____ In Jail: Years____.__. Months, Code ® v Amount $ Suspended: Years______. Months______. N. Drug Seizures ~ Date: . Restitution Date: ; (Court Ordered [7] Pretrial Diversion Probation: — Years______. Months_. Drug Code * ; Code * v Amount $ Fines: i sere Weight ________. Code PELP Date: . FDIN ates y Do not indicate $ in Section D Code * v Amount $e 1, Disruption/Dismantlement: Vv E. Hostages(s) Released Date:. — q icti ges(s) Disruption Date: O. Child Victim Information b Released by: (Terrorist [7] Other ‘ Child located / identified Date: oY Dismantlement Date; : Number of Hostages: Ku i ‘Op . Completion of FD-515a Side 2 Mandatory wing : [) Deceased > P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, Land N | | Race* | Sex | ate of Birth Social Security No. (if available) b6 a a De ee Subjact related to NA Digi A lalian Organized Crime (OC), Russlan/Eastern European, Carthbean, or Nigenan Organized Cnma Group + Complete FD-518a, Side 1 Bi propriate. Subject related to an OC/Dnug organization, a VCMO Program National Gang Strategy targal group, or a VCMO Program Nationa! Priority {nitlalive target group - Complate FO-515a, Side 1 Blocks A-C only. x Additional information may be added by attaching another form or a plain sheet of paper for additionat entries. Serial No, of FD-515 e See codes on reverse side, | —“(Csi‘sCizr ~“ 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-UH - (0&062- 17% HOUSE_OVERSIGHT_021574