Generic Law Enforcement Investigation Form (FD‑515) with No Specific Actors or Allegations

*; Pal : D-515 (Rev. 12-19-08) Squad supervisor approval (please initial) File Number Drugs A Fugitive Bankruptcy Fraud Computer Fraud/Abuse Corruption of Public Official 7] Money Laundering Sub Invest Asst by FO(s) Asst. FO(s) A. B.C. D A. Complaint / Information/ Indictment ((Federat [)Local Complaint Date: Check if Civil Rico Complaint O bbooo (1 International Information Date: Indictment Date: B. Locate / Arrest (Federal [JLocal [7 international - Subject Priority: 1A OB (1c Locate Date: Arrest Date: (2 Subject Resisted Arrest DD Subject Arrested was Armed Cc. Summons Date: (Federal [] Local D, Recovery / Restitution / PELP X (]Federal [JLocal [J International Recovery Date: Code * v Amount $ Code * ¥ Amount $ Restitution Dates. [1] Court Ordered {[] Pretrial Diversion Code* sy = Amount $ PELP Date: Code*_ ss ¥ «Amount $ E. Hostages(s) Released Date: Released by: [1] Terrorist [1] Other Number of Hostages: Accomplishment Report (Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment) 2, Helped, minimally 1A) Rate FO ° [Finan |_| ELSUR / FISC ELSUR/T. Ill [eve Purchase] | F. Conviction (Federal [Local Conviction Date: (JJ Intemational Subject Description Code c (a For 6F, G, H-Include Agency Code (J Felony or (] Misdemeanor (] Plea or CI Trial State: Judicial District: G. U.S, Code Violation Required for sections A, B, F and J (Federal Only) Title Section # Counts H. Sentence Date: Sentence Type: ' In Jail: Years. Suspended: Years. Years. $ Probation: Fines: {. Disruption/Dismantlement: “ Disruption Date: Dismantlement Date: Completion of FD-515a Side 2 Mandatory Investigative Assistance or Technique Used 4, Used, but did not help For Sub. Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO {AT Rate FO \AT Rate FO (AT Lab, Field Sup | | | UCO - Nat.Back |_| |__| Pen Renisters | lM cavervicae| | Proto coer [roversn | P Tsocast_| | [Eton Ta Res | P [invowinio [| [vco-crups |_| tak ov. exam| | |vco-crupit] — 6 29/08 y b6 b7c b7E Date Prepared Date Loaded Date Loader’s Initials 3. Helped, substantially 4. Absolutely essential free Pd Photo Cover | | fe ERT Asst, swe |_| on iro | Boros] | J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: Viet-Witn Coor Judgment ____ Judicial Outcome. Amount $ Suspension: Years °x Months. K. Administrative Sanction Date: Subject Description Code Type: Length: |_| Suspension (J Permanent {_.} Debarment or (} injunction Year. Months L. Asset Seizure Date: Asset Forfeiture Date: CATS # Mandatory ___ESEE 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: Months___ Months. Months N. Drug Selzures Y Date: Drug Code ® Weight FDIN Do not indicate $ in Section D Code * 0. Child Victim Information Child located / identified Date: PRriving ofzofpray (C1) Deceased P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, |, L and N Sex : Date of Birth Social Security No. (if available) es ee ee ee Subject related to an LCN, Asian Organized Crime (AOC), Italtan Organized Crime (10C), Russlan/Eastern European, Carlbbean, or Nigetian Organized Came Group - Complete FO-5152, Side 1 Blocks A-E mandatory, F-H as appropriate. Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy torgel group, or a VCMO Program National Priority Initiative largel group - Complele 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 v Requires that an explanation be attached and foaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures. BIE Un (08062 — 194 HOUSE_OVERSIGHT_021608