House Oversight Form with No Substantive Allegations

® * si Vv, 12-19-06) Accomplishment Report Date Prepared 9/0 ‘4 b6é quad supervisor approval (Accomplishment must be reported and loaded into Date Loaded t Os please initial) ISRAA within 30 days from date of accomplishment) Date Loader’s Initial: Investigative Assistance or Technique Used Accomplishment involves: (check all that apply) File Number 1. Used, but did not help 3. Helped, substantially \3/€-MIM-168 CZ] 2. Helped, minimally 4, Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Rate FO \AT Rate FO IAT 7 Lab. Field Sup Aircraft Asst, | | Pen Registers L [Photo Gover_| | [Povyerepn | | | Rate FO AT Rate FO [AT [| Juco-nasoa] I rsa | Bankruptcy Fraud Computer Fraud/Abuse Corruption of Public Official Money Laundering Sub Invest Asst by FO(s) Stat Agent Name Computer || Consen Mon. | | DOOODOoO LRA | Squad Asst. FO(S) PUA PR-2 ELsUR/FISC| | ‘|Search Warrant] [NNN Crisis Nog. Local | Assat Fort Prog A BG. De | | | __FRRR show money BER ERT Asst. | NM Ford Support Proj Assisting Agents Soc, Sec. No. * ee &Ng. Field Spt | _|socass. |_| i Butte - ITC | | TFOS/CTD oc oc [[uco-croupr | fi Fe tengo |_| [Juco coun ilvon rianex) | | J. Civil Rico Matters Date: Also complete “Section G” Other Civit Matters Date: CXSICTD infraGard/CyD OFCICID Swat Team Tech. AgiEquip. Phone Toll Ree 4 Eng. Tape Ex. Pe J [evs Purchos| ee ee hee | F, Conviction A. Complaint / information/ indictment (Federal [Jtocal [] International [Federal [Local [7] International Conviction Date: Complaint Date: ELSUR/T. Ill Check if Civil Rico Complaint O Subject Description Code *“—)" gant ; ° Judicial Outcome____.§__ OK Information Date: For 6F, G, H-Include Agency Code Amount $ Indictment Date: = Palony , OF 5 MISHENEAGE Suspension: Years Months. Plea or Trial B. Locate / Arrest State: Judicial District: [J Federal [Locat [J International Subject Priority; OA (1B [1c 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 (7) Subject Resisted Arrest (1) Subject Arrested was Armed L, Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory.__ EE Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal C. Summons Date: (} Federal ([] Local D. Recovery / Restitution / PELP X (Federal [Local [7 International Recovery Date: Code * vy Amount $_ Code * v Amount $ Restitution Date: Do nat 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 “Date: (Court Ordered ([] Pretrial Diversion Probation: Years Months_____. Drug Code © Code * Y Amount $ Fines: $ aa Code FELF Date: @ Do not indicate $ in Section D Code*__ vy) =Amount $ 1. Disruption/Dismantlement: “ E. Hostages(s) Released Date: Disruption Date: Released by: [[] Terrorist ([} Other 0, Child Victim Information Child located / identified Date: 0fzofroy PRuving (1 Deceased Dismantlement Date: Number of Hostages: Completion of FD-515a Side 2 Mandatory b6 b7C P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks &, |, Land N | Race* | Sex | DateofBith Social Security No. {if available) PS Ga | OO Subjact related to an LEN, ASian Organized Crime (ACC), ttallan Organized Cnme (IOC), Russian/Eastern European, Caribbean, or Nigerian Organized Crime Group - Complete FD-515a, Side 1 Blocks A-E mandatory, F-H as appropriate, oO Subject related to an OC/Drug organization, a VCMO Program National Gang Stralegy targel group, or a VCMO Program National Priority Initiative targel group - Complate 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. selal NG: GLFO-aIe ~ Sad atlas SHTSVEIES Side, Pp ¥ 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-MH - (08062 - 20g HOUSE_OVERSIGHT_021632