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Date Aircraft Make Aircraft Points of Departure & Anhral Mies Rigtt Remaks, Procedures, Number Aircnift Category."
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Mod&I Identification
Mark Flown No. llllaneuwers, Endorsements of Landings
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I certify that Ile slalements made by me on this form are true. Page Total
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Date Aircraft Make Ai'o-aft Points of Departure & Anival Miles Fight "-*S. Procedul9s, NurTt>er Ain::,aft Catego,..,.
19_ and Model ldentficalion Mark Rown No. Man--., Endorsements oflandings
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I Cll!r1ily that the stalements made by me on this form are true. Page Total 'V\o n.lo s
Amount Forward lh'\-·•C C\ \ C,$ S" 6111 3 I:> \ \ ~:Ln
Total to Date b1~S .....,.-0e.JJ. f2au-#'4-- 92.i...1 i ·3 \2..~ (,."\(,.,<;"
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:J.-,1 104
Date Ai-craft Make Arcraft Points of Departwe & Arrival Miles Flii,,t Remalls, FTocedures. Number Aircraft CategorJ ...
-19'.:: and Model ldentificatioo Mark Flown No. Man-rs, Endorse,-nts oflandngs
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I certify that 1hestatements made by me on llis fonn are true. Page Total L/'i 12
(.Tl.~ Amount Forward lh-:\E,~ 't21.7 s "=\ r, \ 2.S t1 b1'.)tt
Pi~ts sowill~t L,.· Total to Date r-11.«~,S"
7 b';-~ :, ;, \ '.l.5 0
105
Dale Aircraft Make Aircraft Points of Depature & Anival Mijes flight Aenatb, Proced-, ~rrbet Aircraft Categoay •..
and Model ldenification Mark Aown No. Maneuvers. EndGn-nts ct lardings
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I certify that the statemercs made by me on ltiis fonn are true. Page Taal (o/c., Li-5 6
Amourt Faward Y..1~ 9l.'OS' ri :, ?, \ ?...S- 0 b·144t
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106
Date Aircraft Make Aircraft Points of Depature & Antval Miles Aigit Remarks, Procedwes, Nurroer Aircraft Catego.,,... and Model Identification Mark Flown No. Maneuvers, Endorsements of Landings Co'-! From To ti~
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I certitylhal !he Slatemen!s made by me onlhislormare true. Page Total '/\ ~1 :,
Amount Forward fl~:t qn\ <i 3 t, \'J..S 0 iJSC> Pilot's Sf~ture q,v-ZJ ,Pc Total to Date
~ .-..,G, '1~'!8 B ·3 :> ').$
107
Date Airaafl Make Aircraft Paintsof Depatwe & Arrival Mies Flight Rema"'s, Procedures, Numbe- Aircraft Category._ -tr::: and Model ldaitification Mark Rown No. - llaleuvers, Endorsements a landings 2 D:l4 Fran To 1\-~~- (?L~ \1⁄4~(£1,'~
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6 , I certify that the statements made by me on this fonn are true. Page Taal 9/t+ 3 I
Amount Forward IF-1~f. Cf,~ 8 :> 3 l '.2.5 (\
Pla'S Slgnatu~C'-LJJ '-i., Total to Date "i1\; 94·,11 ·3 '3 \ 1...'SJL' '
108
Dale AiroratMake "- and Model Aircralt PIDints of Departure a Arrival I.ties Fight Aemat<s,PN,cedureS,
ldenl1f,cationMark
To
Flown No, Maneuve.s,E~nt• Number Aircraft Category_ ~c,u4 From oil.endings
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Date Aircraft Make Aircraft P<tints of Departure a. Arrival Miles F¥ghl RelllWlul, Pl'oeedules. NurTt>er Alroaft category•.. and Model loontification MaJ1< Flown No. ...,_vers, Enclonements d Lancmgs -
Fran
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I ca1ily that the Slalemerts made by me on this form are true. Pagelolal \l/q t:"'l. 5
AmoUlt r;;:~t:,ii:, Forward ; . ~,, 94·11 j 3 \2..S 0
(,111 Piklt's Signature~ a;_j (2_eJ v~ Total 11D Date b'\RL '{ 51>2.. 3 :> \2.S l\
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Date Aircraft Make Aircraft Points ol Depatwe & Alrlval Mies Fllght Remartts, Number Ain:nft CateVolY••
3'ldModel ldenlification Mark Flown No. Maneuvers, Endonements otLandrgs
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I certify lhat 1he statements made by me on tlis fonn aie IJIJe. Page Taal h/~ 5-5 I 2.. 2-
Arna.mt Forward m1 9531.3 3 3 \1$ t:.11'<1:,
SJgaa1u~)~~ P.b~ Tolal to Date b~qq '1~1 Lf .3 j21 11
111
l
Date AraaftMal<e Aircraft Paints ofDepature & Amval Miles Aighl A-ks, Procedures, flunbef Alicraft Category••
,.,~ and Model ldentfficatioo Mark Aown No. Mane111VerS, Endorsemmtts of Landings
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112
-
Dale Aircraft Make Airaaft Points ofDeparture & Anhral Miles Rig,! Remart'5, Pl'ocedures, Numbe< Aircraft Categor!J .•.
and Model lderiifica~oo Mark Rown No. lla,...,_rs, Endcwsements ofLandings * From To (-\~~')lt He~\
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I certifythat the stalemeols made by me on this brmare true. Page Total 7/5 35 \ 3
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113
Dale Aircraft Make Airaaft Points of Depart•e & Anlval Miles Right Remalks, Procedllres, Number Aln:ratt Category_
and Model Identification Mark Flown No. lllane1Wers, Endor-nts ollandngs - ·
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I certify lhat Illestatements madeby meoo fls t01m are true. Page Total 91£.., ~i
Amount Forward qb7~ 9 ':\ :, \ 1.'\ 4
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114
Date AlraaftMake Alraalt Points of Depatunt & Arrival MIies Fight Remaltcs, Procedwes, Number Aircraft Category.•
and Model ldertificatlon Mark Flown No. lla,_.,..,rs, Endorsem-ts ol Landings
From To c;.~ ,~1,
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I certify that the Slalements made by me on Chis lolTTI are true. Page Total lb/b So
Amount Forward ti~\ 9711 0 :, 3 P·-'-\ '-I·
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115
Dale Ain:ra!IMake Ain:raft Poinls of Departure & Arrival t.iles Righi Remarlls, Procedures, NIMli>er Aircraft Category_
-
and Model Identification Mar1< Aown No. Maneuvers, Endorsements of l andngs
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I certify that the state ments made by me a, !tis fonn are true. Page Tolal 12-7n YS 4 Amount Forward 1P~,IJ Cf7(q Lf 3 IA't 4
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