EFTA00129463

FD-515 (Rev. 12-19-06)

Squad supervisor approval

(please initial)



Date Prepared 12/15/09

(Accomplishment must be reported and loaded into ISRAA within 30 days from date of accomplishment)

# Investigative Assistance or Technique Used

1. Used, but did not help
2. Helped, minimally
3. Absolutely essential
4. Sub Invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO

## A. Complaint / Information / Indictment

- **Federal** / **Local** / **International**
- **Complaint Date**: Check if Civil Rico Complaint
- **Information Date**: Indictment Date

## B. Locate / Arrest

- **Federal** / **Local** / **International**
- **Subject Priority**: A B C
- **Locate Date**: 12/08/09
- **Arrest Date**: Subject Resisted Arrest
- **Subject Arrested was Armed**

## C. Summons Date

- **Federal** / **Local**

## D. Recovery / Restitution / PELP X

- **Federal** / **Local** / **International**
- **Recovery Date**: Code ✓ Amount $
- **Code✓ Amount $**
- **Restitution Date**: Court Ordered ✓ Pretrial Diversion
- **Code✓ Amount $**
- **PELP Date**: Code✓ Amount $

## E. Hostages(s) Released Date:

- Released by □ Territorial □ Other
- Number of Hostages: ✓

## P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, L and N

### F. Conviction

- **Federal** / **Local** / **International**
- **Conviction Date**: Subject Description Code • (•)
- For 6F, G, H-Include Agency Code
- **Feiony** or **Misdemeanor**
- **Plea** or **Trial**
- **State**: Judicial District:

### G. U.S. Code Violation

- Required for sections A, B, F and J (Federal Only)

### H. Sentence Date:

- Sentence Type:
  - In Jail
  - Suspended
  - Years Months
  - Probation: Years Months
  - Fines: $

### I. Disruption/Dismantlement:

- Disruption Date:
- Dismantlement Date:
- Completion of FD-515a Side 2 Mandatory

### J. Civil Rico Matters Date:

- Also complete "Section G"
- Other Civil Matters Date:
- Judgment
- Judicial Outcome
- *x*
- Amount $
- Suspension: Years Months

### K. Administrative Sanction Date:

- Subject Description Code •
- Type:
  - Suspension
  - Permanent
  - Debsement
  - Year Months

### L. Asset Seizure Date:

- Asset Forfeiture Date:
- CATR's Mandatory
- Circle before one of the three asset foreclosure:
- 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✓ PDN
- Do not indicate $ in Section D

O. Child Victim Information

Child located / Identified Date:
- Living
- Deceased

### P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, I, L and N



* Additional information may be added by attaching another form or a plain sheet of paper for additional entries.

* See codes on reverse side.


* See codes on reverse side.

√ Requires that an explanation be attached and loaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizure.

72-MM-113327-17

EFTA00129464