House Oversight FD-515 Form – Procedural Checklist with No Specific Allegations

a FD-515 (Rev. 12-19-06) Squad supervisor approval (please initial) Accomplishment involves: (check all that apply) Computer Fraud/Abuse Corruption of Public Official (1 Money Laundering | Sub Invest Asst by FO(s) Asst. FO(s) A. 8. C.D. i A, Complaint / Information/ Indictment [Federal [Local Complaint Date; (1 Intemational Check if Civil Rico Complaint [J Information Date: indictment Date: B. Locate / Arrest [Federal [Local Subject Priority; [JA [1B Locate Date: fic Arrest Date: (2 Subject Resisted Arrest (2 Subject Arrested was Armed Cc. Summons Date: (i Federat [7] Local D. Recovery / Restitution / PELP X (Federat [Local [] Intemational Recovery Date: : Code * v. Amount $ Code ° y¥ Amount $ Restitution Date: [1 Court Ordered ([] Pretrial Diversion Code* ey =Amount $ PELP Date: Code*__ y= Amount $ E. Hostages(s) Released Date: Released by: [1] Terrorist (7) Other Number of Hostages: P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, Il, Land N RDrCt N File Number (1) International - Accomplishment Report (Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment) tAT Rate FO BE Finanayst | | esr |_| Bn. Tne Ex eo cw io | F. Conviction [1 Federal (Local Conviction Date: (1 Intemational Subject Description Code *(__) For 6F, G, H-Include Agency Code (] Felony or (7 Misdemeanor (J Plea or (Trial State: Judicial District: G, U.S, Code Violation Required for sections A, B, F and J (Federal Only) Title Section H, Sentence Date: Sentence Type: In Jail: Years. Suspended: Years Probation: Years, Fines: $ |. Disruption/Dismantlement: Disruption Date: Dismantlement Date: Completion of FD-515a Side 2 Mandatory Investigative Assistance or Technique Used 41. Used, but did not help 2. Helped, minimally For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO IAT J vircrattAsst, | | | Pen Registers | | = eset [| [eensenton | I Poverenn | | feusurvrisc| | [search warrant] | Show Money | socasst | | | [UCO- Group | Lab, Div.Exam] | Juco-croupn |_| Date Prepared O 9/29 of Date Loaded _ "30/0 b6 Date Loaders Initials |__| b7Cc b7E 3. Helped, substantially 4, Absolutely essential Rate FO \AT Rate FO 1AT [| Juco-nasoa] BE crimus intt ass | }orsis Nea Fed| | crisis Neg Local | | BPERT Asst || Meute-1rc | [EE TFOSICTO CXS/CTD me Sav - ITC || Poc-ITC | NE InfraGard/CyD OFCICID lee | . = _ _ occ Brcorae| || J. Civil Rico Matters Date: Also complete “Section G" Other Civil Matters Date: Judgment Judicial Outcome__ —_ eX Amount $ Suspension: Years Months__ K, Administrative Sanction Date: Subject Description Code Type: Length: Fetament C1 Permanent Debarment or Months Injunction Year, L. Asset Seizure Date: Asset Forfeiture Date; CATS # Mandatory __EE 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: Months___ Months____ Months______. N. Drug Seizures “Date: Drug Code ® Weight FDIN Do not indicate $ in Section D 0. Child Victim Information Child located / identified Date: oofg ofroy PRiving (J Deceased Code” b6 b7C [| feces? | Sex [_, Datofoun | Seal Sreviyna aaa) | OS ces Bialed to a Asian Organized Came (ACC), Complete FD-515a, Sida 1 Blocks A-E mandatory, F-H as appropriale. oO Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targol group, or 3 VCMO Program National Priority Initialive target group ~ Complete 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 additional entries. e See codes on reverse side. ‘allan Organized Came (iOC), Russian/Eastern European, Caribbean, or Nigeran Organized Crime Group - 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. BIE- MH - [08062 - 200 HOUSE_OVERSIGHT_021620