House Oversight Investigation Form Template (FD-515) with No Specific Leads

: 12-19-08) quad supervisor approval please initial) File Number Drugs oO A Fugitive Oo Bankruptcy Fraud O Computer Fraud/Abuse O Corruption of Public Official 1 Money Laundering Sub Invest Asst by FO(s) Asst. FO(s) A BC. DL A. Complaint / information/ Indictment (Federal [Local Complaint Date: (7 International Check if Civil Rico Complaint 1 information Date: indictment Date: B, Locate / Arrest (Federal [Local [7 International - Subject Priority, OA (1B Oc Locate Date: Arrest Date: CO Subject Resisted Arrest (7) Subject Arrested was Armed Cc. Summons Date: (Federal [[] Locat D, Recovery / Restitution / PELP X (Federal [JLocal [£] International Recovery Date: Code * vy Amount $ Code ° ¥ Amount $ Restitution Date: ————— (1) Court Ordered {([} Pretrial Diversion Code*__ vy =Amount $ PELP Date: Code * v“ Amount $ &. Hostages(s) Released Date: Released by: [1] Terrorist (F) Other Number of Hostages; P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, L and N ee a ee Subject related to an LCNfAsian Organized Crime (AOC), Nalian Organized Crime (IOC), Russlan/Eastern European, Caribbean, or Nigenan Organized Crime Group = Fort Complete FD-5153, Side 1 Blocks A-E mandatory, F-H as appropriate. Accomplishment Report Date Prepared 2d Q 4 b6 (Accomplishment must be reported and loaded into Date Loaded Os ISRAA within 30 days from date of accomplishment) Date Loader’s Initials b7¢c b7E Investigative Assistance or Technique Used 4. Used, but did not help 3. Helped, substantially . 2. Helped, minimally 4. Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO IAT Rate FO AT Rate FO {AT Rate FO [FinAnayst | MM icp.riete suo | | [uco-natwact| | Pio cover |__| exsur/Fisc | | ‘| search Warant isis Nop.-Looal| | ELSUR/T. Ill ERTAsst. |_| | Jsosass. | Evid, Purchase | [uoo-crovpt | [Foc anoasst |__| fiat. om eam) | _[vco-crovpit] — famgNonrartabex| |_| J. Civil Rico Matters Date: Also complete “Section G” Other Clvil Matters Date: IAT ler | Pd BB Butte - ITC Sav-ITC |_| Beos-no |_| F, Conviction (ClFederal [Local Conviction Date: (7 Intemational! Judgment___.__.____® Judicial Outcome Subject Description Code a “x For 6F, G, H-Include Agency Code (Felony (1 Plea State: Amount $ or Misdemeanor . O Suspension: Years or C Triat Judicial District: Months______. K. Administrative Sanction Date: Subject Description Code Type: Length: Suspension {[] Permanent Debarment ie) Injunction Year. L. Asset Seizure Date:. Asset Forfeiture Date: CATS # Mandatory Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal G, U.S. Code Violation Required for sections A, B, F and J (Federal Only) r Title Months Section # Counts Do not indicate $ value in Section D H. Sentence Date: Sentence Type: M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: Years______... Months Months Months____ In Jail: Suspended: Years N. Drug Seizures “Date: Years, $ Probation: Drug Code ® Weight FDIN Do not indicate $ in Section D Fines: Code * 1. Disruption/Dismantiement: “ O. Child Victim Information Child located / identified Date: Prriving Disruption Date: (Cj Deceased Dismantlement Date: Completion of FD-515a Side 2 Mandatory b6 Social Security No. (if available) bic Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy targel group, or a VCMO Program National Priority Initiative largel group - Complata 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. « See codes on reverse side. Serial No. of FD-515 v 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. B/lE- MH - (0 &062- 207 HOUSE_OVERSIGHT_ 021634