House Oversight Form Template with No Specific Allegations

+ v. 12-19-06) * Accomplishment Report Date Prepared Of, ' Squad supervisor approval (Accomplishment must be reported and loaded into Date Loaded (please initial) ISRAA within 30 days from date of accomplishment) Date Loaders Initials investigative Assistance or Technique Used File Number 1. Used, but did not help 3. Helped, substantially E-MM—(oY0G2 2. Helped, minimally 4. Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Rate FO IAT Rate FO Oj QO Bankruptcy Fraud oO IAT Rate FO 1AT Rata FO Computer Fraud/Abuse O || oe Fin.Analyst | | Lab. Field Sup | || UCO - Nat.Back | | Corruption of Public Official : — see ee AircraftAss.. | | — | Pen Revisters NCAVCIVECAP| _| raceme es = BO iris rit ass Photo C Sub Invest Asst by FO(s) (J P | | oto Cover |_| Crim/NS Intel Asst] —_| (AT . CART Fat Spor leer A. Complaint / Information/ Indictment ()Federal [JLocat [1 Intemational Complaint Date: i a Sr a Asst. FO) Jecsuryrisc[ | [search Warrant] MNEs Noo.-Local| fi cc oon ae cocci] | fee | | soca | flone- ro —| — [Legats Asst, | [MMM Tech. AgiEcuip.| MIB Poc- iro |__| [| [vid Purchase] II Phone Tot Rec] MBFt.Mon.-1ro || TT Fines |] [coc | Peano] [Wiis on en] | [uco-cewpt| erratic] F. Conviction J. Civil Rico Matters Date: [Federal [Local [7 Intemational Also complete “Section G” Conviction Date: Other Civil Matters Date: . ge s Check if Civil Rico Complaint 1 Subject Description Code *(———)* eae oS ——— , udicial Outcome. OX Information Date: For 6F, G, H-Include Agency Code Armauri’s Indictment Date: 5 Peleny or = il Suspension: Years Months Plea or rial B. Locate / Arrest State: Judicial District: (Federal [Locat [international - Subject Priority. 1A [18 {Jc K. Administrative Sanction Date: Subject Description Code ° Type: “Length: G. U.S, Code Violation Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Only) Debarment or Arrest Date: Title Section # Counts Injunction Year. Months (2 Subject Resisted Arrest (J Subject Arrested was Armed L. Asset Seizure Date: Asset Forfelture Date: CATS # Mandatory _ Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal C. Summons Date: (Federal [J Local . Recovery / Restitution / PELP X [Federal [Local [] international H, Sentence Date: Recovery Date: Sentence Type: : Do not indicate $ value in Section D M. Acquittal/ Dismissal/ Pretrial Diversion . (Circle one) Date: Code ve Aman & In Jail: Years.____._ Months, Code * ¥ Amount $ Suspended: Years___——. Months____._. N. Drug Seizures “ Date: Restitution Date;x__ [J Court Ordered ([] Pretriat Diversion Probation: = Years___..__ Months___. Drug Code * - Code*__ sy «Amount $e Fines: §——_______. a Code PELP Date: ’ Do not indicate $ in Section D Code * v Amount $ L Disruption/Dismantlement; “ E, Hostages(s) Released Date: Disruption Date: Released by: [1] Terrorist [[] Other O, Child Victim Information Child located / identified Date: b[20/ oY buiving _ [Deceased Dismantlement Date: Number of Hostages: Completion of FD-515a Side 2 Mandatory Ey P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, Land N a ee ee ee ee 0 Subyect related to an LCN, Asian Organized Crime (AOC), alian Organized Crime (1OC), Russian/Eastern European, Caribbean, or Nigerian Organized Crnme Group - Complete FD-515a, Sido 1 Blocks A-E mandatory, F-H as appropriate. oO Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy targa! group, or a VCMO Program National Priority (nilialive targel group + Complete FO-515a, Side 4 Blocks A-C only, x Additional information may be added by attaching another form or a plain sheet of paper for additional entries. Senge. of res 1s e See codes on reverse side. | sd 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/IE-MM- 1080b2- [py b7c bT7E b6 b7C HOUSE_OVERSIGHT_021592