Generic Law Enforcement Accomplishment Report Form (FD-515) with No Specific Actors or Allegations

Accomplishment Report (Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment) D-515 (Rev. 12-19-06) Quad supervisor approval (please initial) 4. Used, but did not help 2, Helped, minimally Eng. Tape Ex. | | Bankruptcy Fraud Rate FO IAT Rate FO IAT Rate FO IAT Rate FO IAT Corruption of Public Official Aircraft Asst. | [PenRegisters | | Bcavervicap| | Money Launeeting BB compuicr [| Photo cover | EM cinms netass| MB sare | |__| onsen mon || [crisis Neo-Fecl_ MCART Asst. FO(S) | esunvrisc| | [search warrant] (IMME isis ton Locat| II Asset Fort Prog Evid, Purchase _ InffCW Info Lab. Div. Exam F, Conviction (7 Federal C] Local Conviction Date: A. Complaint / Information/ indictment CJFederal [Local Complaint Date: Check if Civil Rico Complaint C1 (7 International (71 Intemationa! Subject Description Code ‘Cie For 6F, G, H-Include Agency Code (Felony (Plea State: information Date: or ([] Misdemeanor or 0 Trial Judicial District: Indictment Date: B. Locate / Arrest (Federal (Local Subject Priority: [A ([]8 Locate Date: (7 Internationat - tic G, U.S. Cade Violation Required for sections A, B, F and J (Federal Only) Title Section # Counts Arrest Date: (1 Subject Resisted Arrest (ZF) Subject Arrested was Armed Cc. Summons Date: (i) Federat [7] Local D, Recovery / Restitution / PELP X (Federal [Local [J International Recovery Date: Code ® vy Amount $ Code*.__y Amount $ Restitution Date: a [1 Court Ordered [[] Pretrial Diversion Code*_ v= Amount $ PELP Date: Code * H. Sentence Date: Sentence Type: Months. Months___. Months___ In Jail: Years. Suspended: Years Probation: —_- Years. Fines: $ ¥ Amount $ L Disruption/Dismantlement: “ E. Hostages(s) Released Date: . . Disruption Date: Released by: [] Terrorist [7 Other 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 Dat¢ of Birth Social Security No. (if available) ‘an Organized Crime (ACC), Ilalian Organized Crime (1OC), Russian/Easlern European, Caribbean, or Nigerian Organized Crime Group - ne: Subject related to an LGN, Ad Complete FD-518a, Side 1 Blocks A-E mandatory, F-H as appropriate, Subject related to an OC/Drug organization, a VCMO Program National Gang Stralagy target group, or a VCMO Program Nalionat Priority Inilialive targel group Complale 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. e 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. 3/6- Investigative Assistance or Technique Used For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Eng. Field Sp.| | | soaAset. Swat Team Phone Toll Rec | [veo creuet | [[uc0-cruoin| J. Civil Rico Matters Date: Date Prepared C129 Date Loaded __7 | F0/ O& be Date Loader’s Initials 3. Helped, substantially 4, Absolutely essential Bexne-tro | ewe |_| re BB Fionve [| ionFariaoes| | TFOS/CTD InfraGard/CyD OFC/CID Also complete “Section G” Other Civil Matters Date: Judgment Judicial Outcome. re ee Amount $ Suspension: Years ex Months K. Administrative Sanction Date: Subject Description Code Type: Length: Suspension [5] Permanent Debarment Injunction L. Asset Seizure Date:, Asset Forfeiture Date: CATS # Mandatory Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal or Year. Months. Do not indicate $ value in Section D M. Acquittal/ Dismissal/ Pretrial Diversion (Circle one) Date: N. Drug Seizures ~ Date: Drug Code © Weight FDIN Do not indicate $ in Section D O. Child Victim Information Child located / Identified Date: b/ 20) oy Ktiving (1) Deceased Code ® Serial No. of FD-515 UY ~ (98062-/90) HOUSE_OVERSIGHT_021580