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FltPlan.com eAPIS Departure Manifest N491GM Time Submitted: 11:58:24 Aircraft Color: BLUE YELLO WHITE CHARLOTTE AMALIE to HIGUEY Confirmation #: EAPIS-3132201 Decal Number: 1513870 Date Submitted: 02/13/2012 Aircraft Registration: N491GM - (B407) Departure Airport Information: Airport ID: TIST City Name: CHARLOTTE AMALIE State: VQ Local Departure Date: 02/13/2012 Local Departure Time: 15:30 Estimated Border Crossing Location/Time: AGUADILLA PR AT 2048 UTC Arrival Airport Information: Airport Ident: MDPC City: HIGUEY Country Code: DOM Local Arrival Date: 02/13/2012 Local Arrival Time: 17:22 Foreign Airports) Landing at within 24 hrs of U.S.A. departure: None Aircraft Operator Information Aircraft Operator’s Company Name: FREEDOM AIR INTERNATIONAL Street: 3800 SOUTHERN BLVD Apartment or Suite #: 204 City: WEST PALM BEACH State: FL Zip Code: 00802 Country Code: USA Phone: 9178686145 Fax: N/A Email: LVJET@AOL.COM Aircraft Owner Information Aircraft Owner’s Company Name: FREEDOM AIR INTERNATIONAL, INC Street: 3800 SOUTHERN BLVD SUITE 204 Apartment or Suite #: City: WEST PALM BEACH State: FL Zip Code: 33406 Country Code: USA Phone: 917-868-6145 Fax: Email: LVJET@AOL.COM Total Number Of Crewmembers: 2 Name: TODD BURNS EARLY Crew Catagory: CREW Sex: MALE Date Of Birth: City Of Birth: PITTSBURGH State Of Birth: PA Country Of Birth: USA Country Of Residence: USA Country Of Citizenship: USA Crewmember’s Permanant Address: Document 1: PASSPORT Document 1 Number: No 2nd Document Provided Name: LAWRENCE PAUL VISOSKI Crew Catagory: PILOT Sex: MALE Date Of Birth: I City Of Birth: BERWYN State Of Birth: IL Country Of Birth: USA Country Of Residence: USA Country Of Citizenship: USA Crewmember’s Permanant Address: Document 1 Exp.: 02/17/2017 Document 1 Country.: USA Document 1: PASSPORT Document 1 Number Document 2: PILOT LICENSE Document 2 Number: Total Number of Passengers: 0 Emergency Contact Information Contact Name: Phone: Document 1 Exp.: 04/21/2021 Document 1 Country.: USA Document 2 Exp.: N/A Document 2 Country.: USA Email: https://ww10.fltplan.com/APIS2SubmittedPrintout.exe?a=4 1/20/20, 9:37 PM Page 1 of 1 HOUSE_OVERSIGHT_004560¶
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