•
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Date +9---- 	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 	- IR • 0/Pk; 	(-LLD 	016
T.2..i -314 	j\ici acid-L-_- 	L F. 13 	E&-r3 	Tc:: i 	to
5..P 	ii 	(IC' 9 	LEI' 9 	n2 	-1-zi 	\ 	°
1 	I ( 	) ( 	LF-P6 	-Z c= \< 	133 	34:24•2,„_ i 0 	1 A 	/ 	S
tc)....,r-q.LL 	-.2.. 	5' 	..,.
:7, INii ^1. :c_-/,-,. 1,65 	_ 2 	.1
9 	G- \E3 	I. I 	.161-; 	c6:_1-) 	VS613•Tc'i 	(-1
IsIL 	T'k_±4-_--_ 	1
-3 	`..)
J.. \ 	(?) --1'Ll --2.) 0 	N)C1 09 .,-re:: 	7:1Y. }(._ 	LP r)-2_. 	\..36 	S 	1..
L1W2- 	f....)6- 	\ ) -7 	V S • t•lk ICCT.tv NrCW.11. 	/ 	_5 	1
OG fc. 	0 ,Ag; 	.y,,,,X.c;iri 	....,,'-eiPtiVi, • o• ..,..Yysy-2-„, '=. c '- . 	. 0 	1.
2_11 	I, 	\ 1 	DN PI i) 	1.1'g'•-)f- • 	Bci 	(Ai.\''‘',."-N PI 110\.)<, LL-S5 Rtm, 1 0 A.& 	y 	D
m 	'i'...)
r..24) 	It 	I t 	-..(:)•;,.p.;\j›)- 	c:r),-(.01--. 	1,,, 	cp,,L ry, ny3,,,,- 	1. 	'4
9.7) 	, f 	1 t 	V:ri <-1- 	:-(c-.7) 	IL)Lf>PrMt-, 	....-1-:, cfpx,:ks. (4_54,, 	zea_. cri,„,1 .
143
7.9. 	. , 	I I 	c: PI (^1-1 	0 CT IN `,--) 	( LHe..1 rj 9 ;!),1 	:se., icr,..1, 	G 	2---
005-1)-- 	Lfrii, 	\ c.15--‘7:Prl,A=,vau 6- 	/k 	G 	-5
I certify Pilot's Sip- 	that the statements made by me on this form are true. -----, .. ...., t..... ..-----L.„.; C LI )1.-4 P/R13/1 	Page Total 	5/ , I tor. 	• ,
Amount Forward 	6S'-'33 6'3-00 	50 i4- 	\
Total to Date 	6.S5'c3 VI-t;ijo 	't-k( 	ir-, 	1 	11 	I