House Oversight Form (HOUSE_OVERSIGHT_021582) – procedural checklist with no substantive allegations

s x Squad supervisor approval (Accomplishment must be reported and loaded into : Date Loaded _& (please initial) ISRAA within 30 days from date of accomplishment) “= | 12-19-06) * Accomplishment Report Date Prepared Ot Z (6) Date Loader’s Initials investigative Assistance or Technique Used 1. Used, but did not help 3. Helped, substantially 2. Helped, minimally 4, Absolutely essential For Sub. Invest, Assist. by other FO(s) indicate A, B, C, D for corresponding FO Drugs oO A Fugitive O O Bankruptcy Fraud IAT Rate FO Rate FO 1a Rate FO IAT Asst. FO(s) A.B. CG. OD. ELSUR/T.I | [RE ShowMoney |_| Bl Eng.Tope ex. | “ME swatTeam || Legats Asst. | [MM Tech. Ag/Equip.| —_| Evid, Purchase | | Phone Toll Rec eran, |_| eute-to |_| swe |_| Poo-ne |_| Fone |_| [_[uc0-crovo | Foc tanonest | — flere | [ise oie Exam] | [uco- croup] lvonrmitepes| [| J. Civil Rico Matters Date: Also complete “Section G” Other Civil Matters Date: Fort Support Pro] CXxSICTD IAT T Computer FraudiAbuse Lab. Field Sup | | — [uco-NatBack] EI Vict-witn Coor nin roar ramet CI | __|PenRegisters | JBMENcAvcrvicaP| NN 10 Wanted Fiyer Money Laundering Fpimistover | ae , Sub Invest Asst by FO(s) |_| over | [MMMBGrinvNS Intel Ass] [NNN SARs [Consen Mon. | MMM Poiyoraph BAM Crisis Neg.- Fed . Evsur/Fisc| | |Search Warrant] [MMMNGrisis Nop Locat| NNN Asset Fort Prog TFOS/CTD F, Conviction 7 Federal ClLocat {2 Intemational Conviction Date: A. Complaint / Information/ Indictment (C)Federat [JLocal {1 Intermationat Complaint Date: Check if Civil Rico Complaint C1 Subject Description Code *(_—_) SITE arene , —a ee Eni Judicial Outcome____ OX Information Date: or nciuce Agency Code Amount $ Indictment Date: = ated ad owe Suspension: Years Months ea or tia B. Locate / Arrest State: Judicial District: (Federal [Local [International - Subject Priority: TIA 08 Oc K. Administrative Sanction Date: Subject Description Code a Type: Length: G. U.S. Cade Violation Required for sections A, B, F and J Suspension [[] Permanent Locate Date: (Federal Only) q Debarment or Arrest Date: Title Section # Counts Injunction Year Months C1 Subject Resisted Arrest (J Subject Arrested was Armed L. Asset Seizure Date:. Asset Forfeiture Date: CATS # Mandatory —_E Circle below one of the three asset forfeiture: Admin, Civil Judicial, or Criminal Cc. Summons Date: (Federal [] Local . Recovery / Restitution / PELP X (Federal ([Jlocal [1] international Recovery Date: Code * v Amount $ Code*. sv =Amount $ Restitution Date: Do not 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: (1) Court Ordered [[) Pretrial Diversion Probation: Years Months____. Drug Code ° . Code * Y Amount $ Fines: $ Weight _______ Code PELP Date: FDIN ate: , Do nat indicate $ in Section D Code * v¥ Amount $ [. Disruption/Dismantlement: Vv . Hostages(s) Released Date: Disruption Date: Released by: [[] Terrorist [J] Other O. Child Victim Information Child located / identified Date: 6 Ee oy Dismantlement Date: 5 Number of Hostages: , ui i D d Completion of FD-515a Side 2 Mandatory: ay - CBecease > P, Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, Land N [$$] Race | Sex | Date of Bi Social Security No. (if available) a se ee ee oO Subject related to an LCN, Asian Organized Crime (ACC), Stalian Organized Crima (IOC), Russian/Easlern European, Caribbean, or Nigenan Organized Crime Group - Complete FD-518a, Side 1 Biocks A-E mandatory, F-H as appropriate, 0 Subject related to an OC/Drug organization, a VCMO Program National Gang Strategy targal group, or a VCMO Program National Priority Imllalive target group = Complete F0-515a, 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. Seval Nool FP b16 e See codes on reverse side. [oe Y 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. B/IE-MH- [08062 ~ 18 / O&8 b6é b7C bTE HOUSE_OVERSIGHT_021582