PERSONNEL STATEMENT FEDERAL AVIATION ADMINISTRATION BOSTON ARTCC This statement concerns thaccident/jncident involving
at
7 7 / 7 L^' I
(aircra"idetificaeon)
(write out location identifier before using the three letter identifier)
(month, day, year and time)
My name is
• ' am employed as an (name and operating initials n parentesis)
by the FAA at the Boston ARTCC, Nashua, NH. (occupation) I was working the
UTC .0
position from (sector and position)
Text of statement:
(time)
UTC.
ffSft
(time)
\TIS%
fl/frv)
OP
TZ>
/VIM c M
fnru I certify, to the best of my knowledge and recollection, the above statement is correct.
•A
n
O&UM VAA&AA
ci\(^io\S
signature ^hTdate)
eu
RM ZBW Form 72 10-45 (Revised 8/98)
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