Date 19n 	Aircraft Make and Model 	Aircraft Identification Mark • 	Points of Departure & Arrival 	Miles Flown 	FII4ht No, 	Remarks, Procedures, Maneuvers, Endorsements 	Number of Landings 	Aircraft Category...
From 	To . 	al:fou401:: 	Gizottlt 	tke.:L.ELc
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I 	,, 	1 ' 	k.)11)C'e 	(7.) ts.. L... 	. 	)
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Pr\ 	m, ,,, „ 4,,,,,,,..4e, -f-v -1-iv, so-f-,e, rt.., ,7 t.1/71.%.,. i et..-ks
xt 	1 I 	(1`1\P 	0E 3 	s -• 1/%0. shot-el/A< 	. 	1
I / 	0 	1) (2 L.	t
-L 	, 	‘ I 	P 13.1._ 	P Iv\P 	aeiv,,,,
2- 	r, t \ 5-95 	N i 0(6.-3-c-= 	PC-3 	Tc---:
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-1-1 	G-0510 	1\)9(6,-.T(2,- 	"Te-0 	„ 7 V( J- 	i.),L1)1.c,N 	c- ,v06e— 6 (?.,:-te- • lints...11A 	2_ 	'3
Lc( 	tt. 	x ( 	i'Ci re- 	1T51-. 	lyjAk 	:1(---'1G-ti`i 	2, 	•-.1)
7h, 	k, 	, 1 	TL-.51- 	er»i 	121-1?	-1-6) Cy ''''‘ 	I / j
3 I 	1 t • 	1 i 	efil". 	6R1.-:- 	i7J-133.-&(<"-?`)/
;-% 	-C Pr 4:- 	Pit )- 	0.6\,4 	..-re-,,G.o,
'1 	i‘ 	i f 	Pi) )- 	 	- i 2.45 	.. c....., , sci  f 	tA 	2 	5
(:\ 	I I 	i,
• "' 	I A 	it. 	eCl• t 	.-Te2-± (?) 	VAL-0 	3-6 12""1 	.2... 	....;-
I certify pilots si,nature 	that the statements made 	by me on this form are true. r?..MP.4i 1, 	Page Total 	, /1 	-2.. 	\ 	,. 6
Amount Forward 	WI-7c -. 	is-di 	ci
Total to Date 	—1C14 2- 	° 	3 	3 	t_..5 (
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