Date +tn..... 	Aircraft Make nrid Model 	Aircraft Identification Mark 	Points of Departure ec Arrival 	Miles Flown 	Flight No. 	Remarks, Procedures, Maneuvers, Endorsements 	Number of Landings 	Aircraft Category...
From 	To 	(i)fl-NY) 	Cy L.TY).--fL 	..
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1....1/ 	1 	1..1 	3
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2_ 	G -1 I SLA 	....._ \_______ 	__
-.54.) 1 , oc....,0) ,,,,,,_,...L77.7'i—v-).... JO 	- 	7
9--o 	\•' \111-(6.1 	•Nit.}:i1P>f . 'J.'', ',..'., ; 	, o,:, i flt.:.t-Lfic-14(..4t, 	1.-1.,(ZST, • r ), 	4\6.44.,4?, 0,,,,L, a_ i) \AU , 0 R 7.1Nc L(: 1/41/.4,. -04C rs-rykrAL,1.1.:,, r.)-03L),5, 1 fac,' A 06
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I, 	IN 	- 1/4. N'. 	is- '13 1:: 	.- 2, V.• • 	--T.Aii 4 r) lJA-Al• %./ 	 .7
1 t• 	1 t 	.. ' 31_, 	rC::.‘-'% 	. 6....CLIJ:..4 A ;u...)e_e,•;%4 , ., 	\/ 	....... 	3
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I certify Pilot's Signatur 	that the statements made by me on this lorm are true. •. , , (.----- ' 4 e  ,L,/,,-), it-e•Otc-. -..,-  	Page Total 	. L.. /11) 	';;;.; 	1 	 t__
Amount Forward 	U 111 L."sciG, 	;.:6- ).:1_ 	3 	").)
Total to Date 	0 i'f• ) l) ')CICA 	, - ..,. '1`3Y.,-1 	• . Lt 	3 	.• 	12---1