T8 B3 Boston Center Peter Zalewski Fdr- Faa Personnel Statement

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PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC

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This statement concerns the accident/incident involving

(aircraft identification)

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, on

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

My name is

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UTC.

(month, day, year and time)

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. | am employed as an

(name and operating initials in parenthesis)

by the FAA at the Boston ARTCC, Nashua, NH.

C PC (occupation) I was working the

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position from

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UTC to

UJJ +/- UTC. (time)

Text of statement:

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

(signature and date)

ZBW Form 72 10-45 (Revised 8/98)

Page 1

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PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC Text of statement continuation: f

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ZBW Form 7210-45 (Revised 8/98)

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Pa9e 2

148

PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC

Text of statement continuation:

-^

ZBW Form 7210-45 (Revised 8/98)

Page J