ZBWARTCC148 PERSONNEL STATEMENT

1 FEDERAL AVIATION ADMINISTRATION

BOSTON ARTCC

This statement concerns the accident/incident involving L. \t

(aircraft identification)

, on \\t UTC.
(write out location identifier before using the three letter identifier) (month,
nth, day, yyear and time)

My name is _. I am employed as an
(nameWid operating initials irTparenthesis)

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

(occupation)

I was working the position from I | UTC to I UTC.

(sector and position) (time) (time)

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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) Page 1

 PERSONNEL STATEMENT
FEDERAL AVIATION ADMINISTRATION
BOSTON ARTCC

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 ZBW-ARTCC 148 PERSONNEL STATEMENT
ML1 1 FEDERAL AVIATION ADMINISTRATION
BOSTON ARTCC

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ZBW Form 7210-45 (Revised 8/98)

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 ZBW ARTCC us PERSONNEL STATEMENT
AAL1 1 FEDERAL AVIATION ADMINISTRATION
BOSTON ARTCC

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\W Form 7210-45 (Revised 8/98)