Date 1g 	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 	A TArLec-c-rtIlirt_ 	Yret r.e..t .
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q 	.c.‘41-t-kb-1. 	Nt-licikC"-r.,\ 	L._
5
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4 14‘.1 2siip,
13 	G-11590 	N'i 9,095-( 	fv\ IN 	1-- co 	1641 	,..t*Reessepairpfrictost ifae•
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_ 	/ 	2 	3
.7) ‘ 	eyn2_11.-?Aq 	i\JID(2,:si,_, 	co 	-Pi)(. 	.7._\1 	. 	9
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1-1 	1 i 	‘ 	Lex 15 	L-6- Y3 	.14w-.0).• NL-t,„•_, Tide., a (;,.?{___,14 5 _ c,..,,m4(- lAr..1:::, C,i,,,,v0 Li...' , 	t_A 	b 0
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'lc, 	`6 --In --Lob 	4_-) .,f,,\ 0 Lai-mx- 	i\A R 	r^.-5=0- 	0,,,,,, ..->14\.11:-. - f...tsi'iTYkx•-1,3;9-. 	'..).— 	C.)
I certify Pilots Signs,. 	that the statements made by me on this form are true. _.... -Ct..). 41V/4 IF.AdIC\01...1...-  	Page Total 	I 4.L 13 	1.0 chs-i. II - • 	1 	,
Amount Forward 	(116i- 4 -34.7 	(1,_ v 	•-1 .., 	'1., — 	1 I 9
Total to Date 	u-11 6 1" 	1161.S 	s. 	3 	' 	W\