Date 19ttio C)C-:( 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure & Arrivall 	Mlles Flown 	Flight No. 	Remarks, Procedures, ManeuVers, Endorsements 	Number of Landings 	Aircraft Category-
From 	To 	NI,- eu.,,,k.,- 	G
(0 	G 5 	Ncto%sc 	-t6,9) 	- 	G
6 	l t _ 	11 	Gc--0 	-1-6-B 	‘10 	Ic--- 	,k-k,-,*),() 	I 	Ti
Dc.,f) 	\\b<6 	/ .1./ rk DipA P.--imt,f_t_e.,-,c., 	(A 	Ti
6\ 	, I 	II 	DcR 	Pc-31-- 	im 	....M.- 6-rAi Aq
11- 	i 1 	t 1 	P5t 	1-6.--(3 	\t_lc, 	-6,._,G rs,‘ N) 	V 	i
1 5 	, I 	1 1 	.1-&-( 	Pr) r 	0-11
/ 	2 	7?—
Q 1 	i r 	t 1 	6.----0 	I-13 	---3.6-
2_ t 	ti 	I 1 	(360 	1-6.6 	\;14 	:--&-) P LP 1J Pc--_.0.54.01:-1---L_ 	\ //) 	S
Pf 	t•-"6 	3-6) G rA i C.-WLIODot-YrJ
No\./ 1 	0 	It 	PC3r 	1-6,(3 	v_16, 	No PC4Sc,-.;,;(:•4:.-'‘t.. 	\A 	2— 	5
1 	.1
\cm 	2-6. 1•c_i_pstex= r4-2...61_, (---)2..nr,,,c., c..4 	\ / , 	2) 	2-
-TI,...-\- 	c)(. 	\pii 	-5,::__)c.,riN, c...L.snek vs1.4-2.1.-,L,•i I;(114 Wk...i', 4 	1 / k‘ 	-2- 	L\
I te) 	. k 	\ i 	Pr3-. 	c TA \-1/4 	k \ y, 1 	--iC- 1(..r."‘ 1 c-t-ociik- waliz,,......,(-0-,_,,,,,„1.3, 	\ / ' 1 \ 	) 	L.)
kL2 	0 	if 	CAN\k 	7 L-e) 	\ 1%2;3(1:1 	GP1\ ( (-;VAN(...03:5 	k / 	\
‘, 	.A.C=-.6 	-1- -.VS-1- 	03 	...1 • GrA I I) 0 	(/. 1
Pç..Nut-c\)-).- c)())-_
I certify Pilot 's signature 	that the statements made by me on -C (... -\ j 0.1..Zeic 1 	this form are true. I . 61-4.— . - 	Page Total 	6i t--1-
Amount Forward 	(0_..... . -7-',.--1. '7, 	119•2•'5 	4 	3 	3
Total to Date 	5-,s9)cr 	13('1. 	S 	-3' 	3