LINE 1 -- DATE AND TIME______________________________(DTG)
LINE 2 -- UNIT________________________________________(Unit Making Report)
LINE 3 -- AIRSPACE___________________________________(Type of Airspace)
LINE 4 -- NUMBER ____________________________________(Name or Serial Number of Area)
LINE 5 -- FROM_______________________________________(DTG Area to be Established)
LINE 6 -- UNTIL_______________________________________(DTG Area to be Disestablished)
LINE 7 -- ACTION_____________________________________(Type Action: ESTABLISH or CANCEL)
LINE 8 -- SERIAL NUMBER______________________________(ACO Serial Number)
LINE 9 -- AREA________________________________________(Description of the Area to be Defined (Boundary or Circle))
LINE 10 -- COORDINATES______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)
LINE 11 -- WIDTH/RADIUS______________________________(Width or Radius)
LINE 12 -- LOWER_____________________________________(Lower Altitude of Designated Area to Nearest 100 Feet or Ground Level)
LINE 13 -- UPPER______________________________________(Upper Altitude of Designated Area to Nearest 100 Feet)
LINE 14 -- CONTACT___________________________________(Call Sign of Control Agency)
LINE 15 -- PRIMARY___________________________________(Primary Frequency or Frequency Designator)
LINE 16 -- SECONDARY________________________________(Secondary Frequency or Frequency Designator)
LINE 17 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)
LINE 18 -- AUTHENTICATION___________________________(Report Authentication)