Nyc Box 2 Aa 11 Dot-faa Docs Fdr- Faa Personnel Statement- Shirley Kula- Operations Supervisor- 38ra 473

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ZBWARTCC148

PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC

1

L. \t

This statement concerns the accident/incident involving

(aircraft identification)

, on

\\t

(write out location identifier before using the three letter identifier)

UTC.

(month, nth, day, yyear and time)

_. I am employed as an

My name is (nameWid operating initials irTparenthesis)

- by the FAA at the Boston ARTCC, Nashua, NH. (occupation)

I was working the

position from I | (sector and position)

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UTC to (time)

(time)

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. IT rervx I certify, to the best of my knowledge and recollection, the above statement is correct.

(signature and date)

ZBW Form 7210-45 (Revised 8/98)

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