Date 44.- 	Aircraft Make and Model 	Aircraft Identification Mark 	Points of Departure 8. Arrival 	Miles Flown 	Flight No. 	Remarks, Procedures, Maneuvers, Endorsements 	Number of Landings 	Aircraft Category...
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I certify Pilot 's 	that the statements made by me on this form are true. Signature) av/c4 1,6(710 L-3- 	Page Total
Amount Forward 	ti.1 (1-1 	c- . . i(3-1 	- 93 	3n
Total to Pate 	1:k 	Ci 1 n 	'3
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