.

ZBW-ARTCC-148
VM_11 PERSONNEL STATEMENT
FEDERAL AVIATION ADMINISTRATION
BOSTON ARTCC

This statement concerns the accident/incident involving at

(aircraft identification)

^ I m V U UTC.
fLj /o/"u . JUeuJ /cm ..on
(write out location identifier before using the three letter identifier) (month, day, year and time)

My name is "vbseipK I UocpQ/", *0 S- (QP-J . I am employed as an

(name and operating initials in parenthesis)

loo/'oll'KTOi/' by the FAA at the Boston ARTCC, Nashua, NH.

(occupation)

I was working the position from UTC to UTC.

(sector and position) (time) (time)

Text of statement:
ex clude/ Wu/ffmj
0 i j,
Tf , JL r a ,ss/\i~T <tn o <? , nvftfess fe
toa5

'fo g)t»e ,

if
» cio not r
oue/e od"

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

(signature aniydate)

ZBW Form 7210-45 (Revised 8/98) Page 1