Date tej-- )11>4. 	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 	Pr Tic ?Lott, 	G Lat.-a 	Re-J-16-4-
1 .1 	(3 -111 • 1 	f‘i 9 °SSC? 	05 	\-- V i\I 	1 	1 fl f " ri6IM 	\ / 	2_
\-\?f\i 	f 6 1" 	cr•A 	:36,6.,4, m.
9 	s&_,c,r,s,
1 	k L. .
50 	To OriPt.1;-e&I)3c5- Li`a(c.c
11-_5-s- 	\)'V N 	26_- Gr, _ f 	1 I 	.
i
• 	V •0, f- 	1_2_c.._ 	 	2
61 	! 	'I, 	\-)1S'i\i 	3 	3-c-.,c, oil, E, . 	V 	-)
1.5, 	.( 	i t 	‘--IFJ•) 	P b .. 	i LI 	-1-`=i6-1'''m 	1 / 1 	i 	C
3 ei 	C- - \ -1 2_ 	AA LkLl -\/ 	1-1\-1A- 	t 6,5, 0 dr6C4.-4-01; 	+Ai-- 	CA 	_
1 	ks 	-"Tr', i G-N\ 1zp_aa" 	1 / 1
7- \ 	t( 	t t 	VI 1\-) 	C`fRK 	.iu1--
--) 	L5110 	0 	J6.-- / C, A1,-. 	A 	LAR
- -7111 L-1D 1U.V3-1-41.- 	5 	5-
0_5 	l( 	\ 1 . 	6-1)(k ik' 	kltr -1\•) 	C'.1 	36'n ( 4....cIt p a.T.11-tz- 	'). 	0
_2, 	•i-p, ,...2-./,5,/
OCT 5 	Lt 	i i 	PK . 	Nk 	OA 	.3- c..
M .-2._ 4,-6-...,-A ry Ltzi 	1 / 	3 	-1
,,, 	\31r IJ 	Z-Pr- 	/v.:,
I certify Pilot's 	that the statements made by me on this form are true. CI_ , Signature  cbot,,e)i  	Page Total 	I 1/114.
Amount Forward 	6611 1-21' 	5.3-2-1 	3 	3 	l 'l 2- (
Total to Date 	t:),Att:'7- 	S 3'3 2_. 	6 	3 	'3 	\ i a_