GENERAL DECLARATION

(Outwardjlnward)

AGRICULTURE, CUSTOMS, IMMIGRATION, AND PUBLIC HEALTH

NATIONAL AERONAUTICS AND SPACE ADMINISTRATION

Owner or Operator···························································································································································-·--·-·······-··-·······················

::n::fitJ and Registration .. ....................... V. ... ~.•. A....................... ~~~~~--M~9.~~9. ...U ....... Date .. .... ~~!.. }.~.1. ... !.~-~?.................
Departure from ....................................MQQN..................................... Arrival at .. ...................tl.9.NQJ._l)J.._"Q...__M._li[~JL..JI.,.!?.•. A.•.. _.............
(Place ancl CounUJ") (l!'len aM CaaDtrJ')

FLIGHT ROUTING
("Place" Column alwaya to list origin, every en-route atop and cte.tination)

NUMBER OF PASSENGERS
PLACE ON THIS STAGE C...tRGO

CAPE KENNEDY

. MOON Dep!rtare Place:

Embarking .......... J~lk ..................... MOON ROCK AND

MOON DUST
JULY 24, 1969 Through on NIL
HONOLULU tame flight ·······-·························-- ···· -~~~!-~?..... _ c..o
Jlaailata Attacbed
AniYal Plaa:

Disembarking ___ __ }JJJ······---····-·····

Through on NIL
aame flight ........................................ .

Penona on board bown to be saBering fl:om illneu other than airsielmeu or

the d'ecta of aeeident-, as well u thole e.-. of illneu ditlembarked during the
SlPt:
NONE

HONOLUlU AIRPORT
Honolulu, Hawaii
fNTERED
Any other condition on board whlch may lead to the spread of dileue:
;

TO BB DETERMINED

=•
Detailti .Of Meh tUaluectbw or ...Utary treatment (plr
tiM ftlaoht. If no dlelneeetinl'" h ,. · ,,..@,_ <!u · ·
li of W)oel neent cllalnaec:ti ,. ·

lllll1 I