House Oversight Form Detailing Investigation Reporting Procedures

‘Squad supervisor approval (please initial) Accomplishment involves: (check all that apply) O O Bankruptcy Fraud Oo Computer Fraud/Abuse Corruption of Public Official [1 Money Laundering Sub Invest Asst by FO(s) Oo Asst. FO(s) A.B. CG. OD. [| A. Complaint / information/ Indictment (C)Federat [Local [7] International Complaint Date: Check if Civil Rico Complaint 1 information Date: Indictment Date: . Locate / Arrest (C)Federal [Local {( International - SubjectPriorty: OA OB Oc Locate Date: Arrest Date: ( Subject Resisted Arrest {J Subject Arrested was Armed . Summons Date: (Federal [[] Local . Recovery / Restitution / PELP X (J) Federal [Local [J International Recovery Date: Code * vy Amount $ Code*__yv =Amount $ Restitution Date: [-] Court Ordered ([] Pretrial Diversion Code*_ ss ¥ =Amount $ PELP Date: Code*__ ¥ ~Amount $ E. Hostages(s) Released Date:. Released by: [[] Terrorist [7] Other Number of Hostages: P. Subject Information - Required for all blocks excluding block D.(Recovery/PELP), blocks E, |, Land N For indictments/Convictions only: - v. 12-49-06) @ File Number Accomplishment Report (Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment) 2. Helped, minimally Rate FO 1A T Fin, Analyst | | Consen Mon. || |_| i pjesur/T i | | [ Eng. Tepe Ex | | Evid. Purchase | | F. Conviction C1 Federal ClLocat [1] Intemational Conviction Date: Subject Description Cade *(i_)* For 6F, G, H-Include Agency Code (1 Felony or (J Misdemeanor (Plea or Tria! State:________.. Judicial District: G. U.S. Cade Violation Required for sections A, B, F and J (Federal Only) Title Section H. Sentence Date: Sentence Type: ' ' In Jail: Years___.__. Months, Suspended: Years__ttttu. Months... Probation: Years.___._.. Months, Fines: $ 1, Disruption/Dismantlement: Disruption Date: Dismantlement Date: Completion of FD-515a Side 2 Mandatory 4. Used, but did not help . | Aircrattasst. | |_| Pen Registers | | | Computer | | | Photo Cover || |_| Pexsun/risc | || seh waren Been | [eocren | i a Fiirowinn [| [uco-creupi | | Fiat oi. Bm | [ueo- Grup] — | Date Prepared OH 29/0 i b7E Investigative Assistance or Technique Used 3. Helped, substantially 4, Absolutely essential For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Rate FO Rate FO AT Rate FO IAT fp NCAVCY Vi-CAP ee (0 Wanted Flyer MB crimms intet Asst] MESARS {crisis Neg Fed| | Crisis Neg.- Local [show Money | AMMerr Asst, | MMM For! Support Pol Pevto-imc || jswatteam | MM sav-rro | [Phone TolRec | MMEFLMon.-iTo | | ca Sa NonFaltabex| | | | J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: Judgment Judicial Outcome, —— —_"% Amount $ Suspension: Years Months K, Administrative Sanction Date: Subject Description Code Type: Length: Suspension (—] Permanent Debarment or # Counts Injunction Year, Months L. Asset Seizure Date: Asset Forfelture 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: N. Drug Seizures “ Date: Drug Code * Weight _____. Code * FDIN Do not indicate $ in Section D O. Child Victim Information Child located /identified Date: bf 29 OX WeLLiving (Deceased b6 b7C Sex Date pf Birth Social Security No. (if available) Oo Subjact related to an LCN, Asion Organized Crime (AOC), tlalian Organized Crima (IOC), Russian/Enstern European, Caribbean, or Nigerian Organized Came 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 Notional Gang Strategy targol group, or a VCMO Program National Priority Inilialive targel group - Complete FD-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. Serial No. of FD-515 ” 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-UH- (06062 ~ | P2 HOUSE_OVERSIGHT_021584