Date 19.13 Pa 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure 8, Arrivat 	Miles Flown 	Flight No. 	Rem4ks, Procedures, Mane Vera, Endorsements 	Number of Landings 	Aircraft Category...
From 	To 	(41:067L114,- 	GLI:ait. 	I16.4-rC,N
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I certify Pilot's Signatur 	that the statements made by me on this form are true. .---, ., I i . (-L ) tl..-r-t 0 a .  	I ___________________________ _ I 	Page Total 	a / 	2.6i 	9 	t \ 	L
Amount Forward 	gilt .--eZ1—.1 t-‘3.'; 	o 	3 	3 	t-N 	i
• Total to Date 	0..,C.41 _...-0 	.... 0 1-?L) k 	ci 	.., 	1 	cci 	(,
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