Ship No.                   Pilot
Date (of forced landing) October 15, 1923       Hour         Minute .M.

LOCATION OF FORCED LANDING

State               County
Post Office (nearest)         R.R. Station (nearest)
Owner (of the landing site)
Damage to property (what and how severe)
Cause of landing (describe)
Damage to ship (describe)
How repaired (Were repairs performed at landing site? If yes, how and by whom?)
How gotten away (By what means was the mail removed from landing site? How was the airplane removed from the site, if not flown out?)
Date (mail removed from site)       Hour       Minute . M.

EXPENDITURES

Cost of oil       Cost of gas
Cost of watchman (to secure airplane, if left at the landing site) per hour
Cost of repairs
Miscellaneous
Pilot's Signature

(For further details use the back of this sheet).

FORM 2344