House Oversight FD-515 Form Template – No Specific Leads

FD-515 (Rev. 12-19-08) @ Squad supervisor approval (please initial) Accomplishment involves: (check all that apply) Drugs oO A Fugitive Oo Bankruptcy Fraud O Computer Fraud/Abuse | Corruption of Public Official [1 Money Laundering Sub Invest Asst by FO(s) Asst. FO(s) A. B.C. OD. A Complaint / Information/ indictment (Federal [Jlocal [£1] Intemational Complaint Date: Check if Civil Rico Complaint (0 Information Date: Indictment Date: B, Locate / Arrest (Federal [JLocal {J international - Subject Priority: OA O18 1c Locate Date: Arrest Date: (] Subject Resisted Arrest (1 Subject Arrested was Armed C. Summons Date: (Federal [(] Local D. Recovery / Restitution / PELP X (Federal [Local [7 International Recovery Date: Code ° vy Amount $ Code * ¥ Amount $ Restitution Date: [J] Court Ordered {([] Pretrial Diversion Code* y= Amount $ PELP Date: Code*_ sv =Amount $ E. Hostages(s) Released Date: Released by: [7] Terrorist (7) Other Number of Hostages: File Number Accomplishment Report é Date Prepared g 'g (Accomplishment must be reported and loaded into Date Loaded a Os” b6 ISRAA within 30 days from date of accomplishment) Date Loader’s Initiafs b7c 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 Rate FO i“ Rate FO IAT iat T Lab Field sup |__| _[uco-NatBock] PenRegisters | _ [MMEMENCAVCy VicAP 10 Wanted Flyer AircraftAsst, | | | Pen Registers | i SARs ‘cteWi Computer Photo Cover |_| ae Crim/NS Intet Asst] | isaRs | |_| Polygraph . eusur/risc| | |Search Warant] MME isis Nep-Loca!| II Asset Fort Prog jertacs. | cr save | Evid, Purchas pep | Show Money Y | |_| SOG Asst. InffCW Info | __[uco-eroup | For, Lang Asst, Lab. OW. Exam| | [uco-Groupit] [IIE Non FBI Lab Ex F, Conviction J. Civil Rico Matters Date: (\Federat [Local [1 International Also complete “Section G" Conviction Date: Other Civil Matters Date: Subject Description Code «(ye Judgment —_ ___. _.___* Judicial Outcome ex For 6F, G, H-Include Agency Code (1 Felony or (1 Misdemeanor (} Plea or (Trial State:-____._ Judicial District: ____ K. Administrative Sanction Date: Subject Description Code G. U.S. Code Violation Type: Length: Required for sections A, B, F and J : : : Suspension [[] Permanent Amount $ Suspension: Years Months (Federal Only) Debarment or Title Section # Counts Injunction Year. Months L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory —— Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D H. Sentence Date: Sentence Type: M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: In Jail: Years____._ Months. Suspended: Years_____ Months_____. N. Drug Seizures VY Date: Probation: Years. Months_____ Drug Code * . e Fines: $— A Code Do not indicate $ in Section D |. Disruption/Dismantlement: a O. Child Victim information Disruption Date; Child located /identified Date: O SFO/zoqy Dismantlement Date: Completion of FD-515a Side 2 Mandatory Aeving [1 Deceased ‘ [| P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, Land N b6 pents/Convictions only: Sex Date of Birth Social Security No. (if available) b7C oO Subject related to an LCN, Asian Organiz Levon {AOC}, Statian Organized Crime (10C), Russian/Eastern European, Caribbean, or Nigenan Organized Cnme Group - Complete FD-515a, Side 1 Blocks A-Efmandatory, F-H as appropriate. Subject relaled to an OC/Drug orgapfzation, a VCMO Program Nalional Gang Strategy target group, or a VCMO Program National Priorily Inittalive target group + Complete FO-515a, Sida 1 BlockwA-C only. x.Additional information mgy be added by attaching another form or a plain sheet of paper for additional entries. menal.NO, OLEDASIS « See codes on reverse side, 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, 3/E- UM - 108062 -20y HOUSE_OVERSIGHT_021628