Date tej---' A.I.Z2, 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure & Arrival 	Mlles Flown 	Flight No. 	-Remarks, Procedures, Maneuvers, Endorsements 	Number of Landings 	Aircraft Category...
From 	To 	(TIPLAftr 	G-1..7alz,
1‘) IS 	1S-121 "31 	Wci 09-11-6 	L 6 Pr 	0 & 0 	Ln 	.3.'‹ 	V k 	-7 	•1 ,
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2-2 	1 ( 	N t 	9131- 	OFJ\) 	s s 	e, GP11 Or) 	1 	/.
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ei 	1 f 	I f 	\APJJ 	LeiI5 	" 	, NIMMI (t „tr, v • 	A
\ -3 	k t 	1 k 	tj- f)03 	&- SS().' 	541::C47-7/ 	_v 	2-- 	2-
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15 	\( 	1 ( 	LF p.4 	6.-X.scA)Li 	(-,1 	:16‘.1 	1
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k CS 	C, -‘151 0 	N ci octi-(.= 	e‘. 	e'64 	isset 	:3-e...- 	\ 7) 	\ 	9
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I certify Pilot's Signature 	that the state nts made by me on this form are true. l aiVItt\ etqij)--- i 1 	Page Total 	t 0 7 	c\ 	0
Amount Forward 	()cal 	Mci() 	'13, 	3 	3 3 	11 \I-
Total to Date 	U9v1 6 tV-A 	_ 5.1-1, 1 	r, 1 	. 3