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ZBW ARTCC 148 AAL1 1
PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC
at
This statement concerns the accident/incident involving (aircraft identification)
I /
, on (write out location identifier before using the three letter identifier) My name is
A/PiEl, D.OUB^^D
(month, day, year and time)
. I am employed as an
( "Bb )
(name and operating initials in parenthesis)
QWW/Uft'T-—
U
(occupation)
*
C
I was working the
by the FAA at the Boston ARTCC, Nashua, NH. (
:
UTC to ~l
position from
(sector and position)
(time)
UTC. (time)
C
Text of statement: f\\^l
i \\- oUcU
o
^—' 4o
O
Aicscc \ (•
I certify, to the best of my knowledge, and recollection, the above statement is correct.
(signature arnttlate)
ZBW Form 7210-45 (Revised 8/98)
Page 1
PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC Text of statement continuation: -^c,
4o We\, AfW
/H T
AV,
^A
OTiS
'To
/A3Te-YU^e/T
U
a ,
3
ZBW Form 721 0-45 (Revised 8/98)
Page 2