House Oversight Form Template with No Specific Allegations

@ Vv. 12-19-06) e' Accomplishment Report Date Prepared cif ZY 3 a b6 quad supervisor approval (Accomplishment must be reported and loaded into Date Loaded b7c (please initial) ISRAA within 30 days from date of accomplishment) Date Loader’s Initials b7E ~ - Investigative Assistance or Technique Used File Number 1. Used, but did not help 3. Helped, substantially EC-MmM-loxoe2 2. Helped, minimally 4. Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Bankruptoy Fraud eS IAT sale FO. IAT.—séRate FO. IAT_~—s Rata FO. IAT Computer Fraud/Abuse Fin. Analyst Lab. Field Su UCO - Nat.Back Vict-Witn Coor A . . ENE B fa Corruption of Public Official | AircraftAsst. | | |PenResisters | | f NCAVC? Vi-CAP } | HB 10 Wanted Fier | Consen Mon, | MM Poyoraph |B crisis Neo. Fea] | |Search Warrant] [IMMMECiss Nop Locat| pecsur/T.i | [BB showMoney | TMM err ass, | [IMM Fart support Pol BE eno rittse | | |socass, | [iMBeute-rrc | NN TFosictD | Ee Ee ee [tegais Asst, | [MMM Tech. AsrEquin.| MM Poo-rc_ | |__| Evid. Purchase] AI Phone TollRec | [MBFt.Mon.-irc | | [iniicwinfo | | [uco-croupt | [For LengAsst.| [pre | [t2b. oi. Exam] | _[uco-Groupt| fl vonrarved | |_| A. Complaint / Information/ Indictment F, Conviction J. Civil Rico Matters Date: ClFederal [Local [J International C)Federal ([]Local [Intemational Also complete "Section G” Complaint Date: Conviction Date: Other Civil Matters Date: . age e Check if Civil Rico Complaint Subject Description Code *(__)» SAT TET . SorBe ve einchudle.& Bek Judicial Outcome__ OK i : or 6F, G, H- le Agency Code ° Information Date: ncluce Agency Amount $ Indictment Date: [) Felony of [1 Misdemeanor Suspension: Years Months (Plea or 0 Trial B. Locate / Arrest State: Judicial District: K. Administrative Sanction Date: (Federal [Local [International - Subject Description Code ; _. G, U.S. Code Violation Type: Length: Subject Priority: TA OB [He Required for sections A, B, F and J Suspension (C] Permanent Locate Date: (Federal Only) A Debarment or Aprest Date? Title Section # Counts Injunction Year, Months (-] Subject Resisted Arrest L. Asset Selzure Date: (C1 Subject Arrested was Armed cae heen Date: andatory Cc. Summons Date: Circle below one of the three asset forfeiture: [Federal [1] Local Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D D. Recovery / Restitution / PELP X a Dat Fed Local ternati wpemence Dake: Tn Es Cee Serienes Tyae: M. Acquittal/ Dismissal Pretrial Diversion Recovery Date: enlence LYPet ' ° (Circle one) Date: Code x Amount & In Jail Years Months___ Code * yv Amount $ Suspended: Years. Months ‘ N. Drug Seizures “Date: Restitution Date: (Court Ordered [F] Pretrial Diversion Probation: Years, Months Drug Code © = Code * v Amount $ Fines: $ iat Code PELP Date: ° Do not indicate $ in Section D Code*_ v ~=Amount $ I Disruption/Dismantlement: VY E. Hostages(s) Released Date: Disruption Date: O, Child Victim Information Released by: [J Terrorist [) Other Child located / identified nae, [20/08 Dismantlement Date: : Number of Hostages: ftivin D Completion of FD-515a Side 2 Mandatory ng [Deceased b6 P. Subject Information - Reqjtired for all blocks excluding block D (Recovery/PELP), blocks &, I, Land N b7c Date of Birth Social Security No. (if available) ébject related to an LCN, Asian Organized Crime (AOC), Italian Organized Crime (IOC), Ruasian/Eastern European, Caribbean, or Nigerian Organized Crime Group + Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate, oO Subject relatad to an OC/Drug organization, a VCMO Program National Gang Stratogy targel group, or a VCMO' Program Nalionol Priority Initiative target group - Complete FD-515a, Side 4 Blocks AC only, x Additional information may be added by attaching another form or a plain sheet of paper for additional entries. Seiial No: of Powe e See codes on reverse side. | —sCY ¥ 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. BA E-HH - (08062 — (G2. HOUSE_OVERSIGHT_021604