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é ey 455N aR sae onthe tee > Sar RDS Aircraft Points of Departure & Arrival SR Fa Identification Mark Flown og J Sema tee leer ne somemteeniatent's een ee i Remarks, Procedures, on : Maneuvers, Endorsements i ao ane a’ on Date Aircraft Make and Model = 5 | J ws . jJ pe 2 i Ud [pale ae | a | = = | ~ Hd [ ‘ , + m4 GS [we WD VA Siar 4 teale DAA ~ _ Pa eb: ~ c - E TNSAGB IN 4A PRE Cs vsiB Ll sie es) - = 40 TAIT Ets Ale —, > ~ ZN |B =a wl NF OATE a =) N S) 3 =, re ie YP x) \( x a a 79 “A/D Bee - i} S STO SINN [He IS RRA fe |S = — _ =_ ~ ~ - ~ A ~ - - Pes tai | canlify that the statements made by me on this form are true. Page Total Amount Forward Total to Date Pilot's Signature HOUSE_OVERSIGHT_022816