Th
Date
Aircraft Make
and Model
Aircraft
Identification Mark
Points of Departure & Arrival
Miles
Flown
Flight
No.
Remarks, Procedures,
Maneuvers, Endorsements
'II
1 t
LX-T
(IGS31'3
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LEv13
Le-vf3
1"
Ni c.cs.)z,-
13\  TG,
Number Aircraft Category...
of Landings
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G--1\S`ki-3
(-XS
N.t
1,
'06x)
.13
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I
133 T_,-4INA
134f.s6:',
1
0
1/1
1s-ci
1S-"5
t-t5
-7
Te7-
t
Lrf)-2_
13
1 t
IC
It
0
15%
Sl)C‘t•tf-L.CJ
C
\A._____________-Jim/ (LLI
l'k'jc'r II5P"\-11:1 °!'"va' L.;)4C' • Tgf.t VC.-;txtnia-t.
_____e4cLyfic..)),t-51fr,iO3-,rii-/,),L211_cre c
ADA&. rck-- L(::65 etili I OP, Lt.r
apt)(z: PW5 IVO b•P?-1-P.AtY,'L
‘I=;furK
1-\*R\-;f- •
143
2.
cyv(.)'>
Th
e
.,:)•ry.,\•),•••
c-IF)
G-
1 \
OCs.i
I certify that the statements made by me on Ibis form are true.
Pilot's Signature
L
Leif;
Pr13ouC.-.
PRA- AIN.).______________rtue:-/L.
itl(-1 5(4
Pr5,r.11.061.)___________________________________
Page Total
/‘
5/
Amount Forward
Total to Date
6S=33
-11-.btQ
\ •3
3 H
k 1)
rJ•
41A