Date 	Aircraft Make and Model 	Aircraft Identification Maric 	Points of Departure & Arrival 	Miles Flown 	Flight No. 	Remarks, Procedures, , Maneuvers, Endorsements 	Number of Landings 	Aircraft Category-.
From 	To 	Axe motor& 	Cr ter.pc-p 	k.-LxcoPlei
1--)- 	072m-31 	N5061.5 	1_ cc 	F 0 t 	(116 9,55 F7z4).0 C...<..ora,.t...- ViNit4.1.1.-,- }Y 	jw./ T 	0
7-‘k 	G-190 	N9 Oclac? 	7' 6 	0 6 	 	'34= RP 	171 	2 	(D
/G.ivi I
9 6 /: 	Ti.\---S-S 	1.k5.5\1°‘ 	/
. 73-- :i
I ' 	7 .61-. 	-ve, 6 	111 	\ /1 	3
cs 	, 	-e: r Y3 	(.1'1 U L 	l5)2 - 	-3-6-1- p-pe% L 11.11. 0.5 NO9[024:10 Av..z.NxL) ia..11111116 	k .) 	\ 	I
\ 2- 	,,,,.,, 	C? \JL, 	--fi& 6, 	\s 3 	ee---C)65):Trod (tA Po :3L, (.67-1_ 0 a LI) 	V t 	\ 	)
-N-6--6 	Pf3 i: 	git.t 	-1-6;-- 	li 	2_ 	3
13 	IL 	)( 	Q 	151,5 	73c= 	1 	2_ 	Li
T&I-15 	e 6 	1,)t, 	\ f--r_2-- reVA Li:: 	2 	3
\ `6 	), 	) I 	iS) E. 	'-c61-9 	ts..1.1 	zsy.„,c,..,,,t, 	I / 1 	2, -
.--V 6:6 	LC-To 	Vi-vis 	CZ 6../tik 	t/ I 	1 	C3
'--43 	1(.. 	LEIV‘ N 	15,ft 	-1-z;jc,pA, IG=./,,,i)1-4,-
a.'5 	1 t 	), 	),_.(--.AAN) 	L-LI\AL 	15:24., 	-1-6'.• I & - iv \ I 1 4.4--: AA ori-e 	\ 	.-3
L F./A t- 	LC---.f "0 	\ 5-2.‘ 	)e-fv\ 	k./t 	i 	1-1
L eyo 	i__10-2., 	1._22..s--4.._,Gm, 	6,:v .-NTI-Lc.,- 	I/ I 	3 	1
L. 9 14 7- 	1' )::ST 	t57.3 	lz--..-)Cs• '-kl co -3-0.ril-c... 	(., 	cs,
. 	I 	A____)__3-7 	c:10•T 	1s2.-1:1-4,) 	tiv, ) \ c-_),,i..e;-
46 	\ , 	\ ( 	e 6 	"Ver--.63 	1.512.5 	----G:i.c.,---„,-Q, pve, is 	1 	2_ 	•-)
s 	ks)4., 	t:.:flyvt, -se.; I 6, mi Acut3,42d- A 	.Li 	9--. 	3
I certify Pilots Sign?* 	that the statements made (---1...--\\_ 	by me on this form are true. ( i 	Page Total 	"Vi 9- 	11-9 	.)--
Amount Forward 	(,,i_i t.;253 'if 	S3 2-3 	Cl 	3 	3 	1 ki, 	G
Total to Date 	C.,1 t., a- 	1.(:63 	1 	3 	,) 	\\ -2_. 	(-,
6e,ccej
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