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Date. 'ta t 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure & Arrival 	Miles Flown 	Flight No. 	Remarks, Procedures, Maneuvers; Endorsements 	Number of Landings 	Aircraft Category...
From 	To 	fali)14)'P& 	GaZg" 	R6L-rezel&P
5 	-h5 	NRoc&-ce_< 	--z..,()-P 	6P.) C; 	m 	1:K.16i
000rg 	l/
45 	I, 	) - 	-vC,.-.;13 	crA4- ._ 	12-% 	1-6. I Ct-9;c2c, 4.02-G-L 	Vt 	i 	4
lzyi 	3-"&i ci-Thec-, yroiz.sr ffu.--) ( I.& 	3
I. 	i'Va 	I-65 	irbt 	4.4.1rii-‘-4e.--/i111%-.(i.", ,In:12:1 (.17M. 	VI 	E 	Lt
1-1 1/4C1 	it C - - Vi l- 	,, 1,12-- - 5 S.?3L- 	-1-&-43 	to i 3 	125,2 	-3;t471AfTuFV.IC-5-e-2-13/ M 	9--. 	9
L m 1) - 	L N 1)- 	Ak. ,./A9.4-, _s-ii:r. --77_4...44.-044
2.° 	G- -1616 	1\11ROSS(::: 	PB-- 	1-67-6 	C2563 	1-4-..),.,...,',..L.L.w6) m 	VI 	2_ 	5
1 W 	2. 	6
2-5 	C-IM2- 	N-2:-5%csi- 	LNI(-- 	C-X6.-.
c...--opo-r14-1-0 c..c-x rtcp4.-..,ver.L. 	r f 1 	5
25' 	C;-\\G-90 	N90(6:3-6 	Peo. 	ns-r 	‘2.,,6s 	Se.-_-,C..-Pli 69, 	V I 	2.
2L 	1( 	1 l 	-Us-r- 	.-I6. 6 T' 	064,,azz, 	c., t-'11 Pe, 	1 /
xi-1 	AL 	I( 	It--(51- 	941 	--1.C.; 	1 / i 	3 	C
/
Ct 	k A. 	1 L 	TI:31-- 	1)(3t 	il:
1 A 	3 	'I
tv's 	3,...5
•Te,
Ili 	I, 	it 	T.-.6 	BED 	lacii 	74, Gt.ii AP, 1 	VI 	1
I certify Pilot's Sign- 	that the statements made by me on this form are true. ' qadra 2/2141112.- .  	Page Total 	11Y Iti 	42. 	%
Amount Forward 	to S4 --5W-----<--- 	-1(.19, 	o 	3 	3 	-ILI 	3
Total to Date 	‘ 2.-1 0 	166"1'4 	3
CCM%