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Date vi--- CAI,/ 	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 	arofox, 	e..,L;;Iy.,2. 	1.1.:t..a
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23 	\ 1 	I 1 	r‘L, (-7 C.- 	1-1f-.6 	ig-n
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rut._ \ e, 	'I..1 	( 	L.- C.--NA's- 	'—f- 9 .6 	.._
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I certify Pilot 's 	that the statements (... Signature 	made by me on this , ""---....1  alpe,c,to-- 	form are true. 	Page Total 	l-r1 	t,
Amount Forward 	 	69)- 	c-:: 	3 	) 	\ I z_.
Total to Date 	b S Lii (c, 'A 14-. 	C:0 4-5 	(1 	f7. 	1 	\ 1—