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Use to request permission to fire across common boundaries from an adjacent service unit. Reference: FM 6-30.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — TARGET NO._________________________________(Fire Support Target Number)

LINE 4 — GRID________________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 5 — DESCRIPTION________________________________(Target Description)

LINE 6 — FIRING UNIT _________________________________(Firing Unit)

LINE 7 — WEAPON_____________________________________(Weapon Type)

LINE 8 — ROUNDS IN EFFECT___________________________(Number of Rounds in Effect)

LINE 9 — PROJECTILE__________________________________(Projectile Type)

LINE 10 — FUZE_______________________________________(Fuze Type)

LINE 11 — EST DTG INITIAL RDS ________________________(Estimated DTG of InitialRounds)

LINE 12 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 13 — AUTHENTICATION___________________________(Report Authentication)

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