Date 49-.- 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure & Arrival 	Mites Flown 	Flight No. 	Remarks, Procedures, Maneuvers, Endorsements 	Number of Landings 	Aircraft Category...
From 	To 	A749.0-01; 	GQ---aa
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2.6 	6 -1 \ _5‘i 6 	N ct oci..SC:-. 	fill: 	'A".::-.....i. 	111-0 	G-i^.1 t-V 	V I
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_
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\ 5Pt 	esi''K cu-i-c:fc -r-m5if.ucpt. visu..cAlA ....0 Cl.-..4.1 	\ 	3
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7.)c, 	00 1-1-1-101 	N Li 9 /GP\ 	Ti.--7-1 -1--S 	- l'P---)./S
L .-.)3". 	I 1:::).-r 	1.....v
tAcijA 	G 1 v5t-1.6 	N.lbcilc-,- 	-1-1.5-T 	'\--• cA f (- 	- t-C2. 	1 V 	/ 1/ 1 	-
t_v 	- 	.
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I certify Pilot's Signature 	that the statements made by me on this form are true. ,........ ( • et/tAWI.j 	Page Total 	v_s- 	.35 	:- 	. 1
Amount Forward 	ti-J1A‘frg:12- 	(16-1 	3 	171-•
Total to Date 	.:1,,k-‘til 	16)3 I 	ct 	3
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