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Date 4g- 	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 	A.'7..--(0C-0-/\t-1 	6-1-2.:YA--e 	1-kt:Lxcoeik4-
.Z 	N ck cc-1)C-Ttk 	L-1(1.t- I 	•c.2 Putuisz C.- vi...D.14:5 e.c...-f- Of 	Yi 	(q
kr4.-1 \\ 	N)90(65e, 	c...-12.-)--31 	p 4 	:7; ,< 	C-13 	:ssa•-)m 	vi 	2_
1% 	---.2-1 -31 	N) 9 oc6:s-c-f. 	-3- c..-: \< 	L93 	ctiA_ 	z&_,cirvi 	• /1 	-7 Y 	-L.
0 	'L...F V C-5.. 	9$ 	. 1
1 7-) 	0. 	1 . 	1_1:e 6., 	ECTCyw 	ci G 	aer-,C,M, 	'i
LGGvo 	Le*TA 1\.) 	co 	-36.-..,ertA, 	V 1 	\ 	9 	cI
I_FMN 	UN fol- 	ckg 	3-e.-..)c.,.m, 	1/ 	6 	1 	.. ...„
.D,() 	1 f• 	\ I 	UN./ 101— 	R.TTP) 	et 9 	Z''‘_-. G PA 	••'-' 	. • t 	6
i r
I k
2.-3 	Ytr5N1.6V.13 	Li 	1 NA
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\r"55 	V T6 0 	103 	Scf-‘61 f)s Avom-. a.,:.• am- Ksaf7 	2_ 	2- 	4 . ,I
I, 	VTO 0 	\MOS B 	IOLA 	ivIme A ps5ove 1:4L5C.—A 	").. 	6 	1 1
2_1 	... 	i ( 	\\4350ws-- 	ITa--le.-.401  6,-.4) 	\/ i 	2- 	1 	1 o ..... I
:Let 	1 l 	1 k 	Vir Ck R. 	\1C11T 	\cc, 	13-6 i GM, 	196115 (7.01I(.,ze 	r-:. 	2_ 	• A
A PrIkdi5 	Li 	Lt 	..:
0 Pi\ 6 	L.fr e 	\ b 	--S6c-,C,rA . fc.71.1.s g!YrNAGe_it 	3 	"3 	1 1
E- ( 	La 	I t 	LC.-T 0 	C.---C.7G-W 	\16-/CrNA,
-7 	I. 	i \ 	-'.C4c. v.) 	6.-:y,) kio 	\\ 	geibs -5.-5-i--- 	1 	1 	.
I certify Pilot's SignaturH: 	that the statements made by me on this form are true. HnOnj a oi t\ Icaric76-, 	Page Total 	67.1 	cl 	/4- 	(.) .. (i
Amount Forward 	I' ifia 	C.../..;SS 	-.3 	3 	I \-4-
Total to Date 	h... ..,,41 to (e)" 1 	B661.2. 	5 	r3 	- 	' 12