Ce~a AIRCRAFT LOG

AND MAINTENANCE RECORD

From _________ 3.J...:--~J ____ l9 h 0 to'-----------.7L----L.../_.l1Ch;L_ _ _ 19 65

Detailing Time From _____ -:-----------To ________________ _ Hours-Minutes Hours-Minutes

Owner ______ ________________________________ _

Address _____ ~----------------------~~----------

REMARKS E nter here A"ene r<~ l cl ;~ t a with refe•·ence t n "Line'' ancl " Perin<llc" •n -t •ec tl nn, - Rt gg'111J.r Chan~o:t' < - .\lte• a tt .,n- - Re1 •:u r< - .en ol t'h:t n~e - 111

propeller o r enA"ine - <~~ nut linecl in t he front nf t hi, bn<•k , under t he headtnl.!. " 1:"\ST RlTT I O:"\S F OR t ' SF: O F 111 1S LOG T:OOK .' ' ALL O AT.\ must bea r the endcwsement o f a ceru ficat et! mechan ic, :111cl ht, nlltll~-t a nd c~ntit ca te n u111 he r tll ll • t be - hnwu .

I have inspected this aircraft and found it complies with the requirements of CAR ,. l· All mandatory changes ·have been comP.Iied w' 1rworthiness dated March· 1 issiDfdl@jt

Executive Engineer

D.\ TE REMARKS

19t, 0 Enter here general <lata with reference tn "Line" anrl "Perinrloc" on -pecto nn, - Rog~;onl( Ch:utJ.:<'' - .\ lteo:oto••ll• -- Rei'«"' - .nod <· h an~o:e' on propeller r• r engine - a~ nuthnerl in the front nf thi , honk. under the hea<hn~r. "1:'\ST Rl TT lO:'\ S F O R l.'SE OF 1 11 IS LOG P.OOK." ALL OATA mui' t bear the end ., r ~ement of a certtficateu onechanic. anrl ho' r«to nl( and ceottfocate nu 111her llltt·t ue '""" n .

...

s--3 /#~1.-L.A-rto,./ op:'" TAI""r~ /~ T-3 Lot-/Z.. A~ F"' - /2-c=-.L n..JJa.~A ~v t:f' AA< 12r , , • ~~ ....

-.-~~~D hu ~- 1't4... --31l 7 '17b~ 1.>.4 rE . t/) ~~

The ~ .... bova dc-sc1·;bed we k constituted a V~ -L ~JJ..v1~~-=--····· Richard W. Scheffner. L -... ·cr 'X UL;.ilO! t apui- altL :rativ!l X- A. E. 396830 (A. I.)' '

--, ' .:t ~H vr;:1~ t)~dcrmcd under tho ·Jrcvi :.:.:<:>ns of Mid· Sta:es Aviation Corporation f"' l1.M l Q Sky Harbor Airport, Northbrook, Illinois

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...

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D .\TE

19

REMARKS Enter here g-enera l ciata with reference t n "Line' ' anrl "Perinrltc'' lll•l'eCttmh - Rtsr~;tnl!' Chant.:<'' - .\lte• att"n' -- Re1•;ur• - .tnol dt<~n~o:e ' tn propeller nr eng-ine- <~• nutlinerl in the front nf thi, bonk , under t he hea<ltn~t. "I~STRtTT I O~~ FOR t '~F. O F ·r Ill S LOG r.OOK.'' ALL DAT A mus t bear the e nd,,r,ement of a cenificateu mechanic. ;~nci ht, rattnl{ ;~nd n rtdtcat e numher 111\l•t Le ,Jt.," n .

....... hours.

19

•

•

D .\TE REMARKS Enter here ,::-ene,·aJ rl;~ta with reference t n " L ine'' anrl " Perinrl1c" ln-pect lfl lh - R i_aglll ll ChanJ.:<'' - .\lte1 ;,, , .. n, - Re l•<tll' ' - ·"'' ' ch;~n ,_e , Ill

propeller nr en,::-ine - a-. n utl111erl in the fron t of t h i, bnnk. under t he head1111l. '' 1:'\ST Rl 'CT !O:'\S FO R t'~F. OF '!Ill S LOG P.OOK.'' ALL OAT.-\ mus t bear the end., r ~ement o f a cert ificated mechanic, anti h" ra t1n,l.( and cert1i1cate numher mn,t l>e 'h"" n .

D .\TE

19

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•

REMARKS Enter here general clata with reference tn "Line"' ancl "Peri nd1c"' in-pectJ n'" - RiJ:!~IIIJl Ch:ul ~<'< - .\lleJ:tl l"ll' -- Rt l'illr< - •• n,J c:han"e' 111 prope ller nr w,r;rine - a' nutlmecl in t he front nf thi, bnnk, under the h«>achnr:r. "I :'\STRtTTIO:'\S FOR t."~F. OF ·r II IS L OG P.OO J.\ .' ' ALL DATA mu~t bear the end.,r~ement of a cert ificat<:d ~nechamc, a nd h'' r<ttllll£ and certlf1care number mu- t be ,),.," n .

D .\ IE REMARK S Enter he re genet·al cla ta wtth teference tn "Ltne·· attrl "Pcttncltc" lll•t•cn1n1t- - Rtl:j.;t ttiC {'lt;~ot~o:<'• - .\lt~':"'"n'. -- Rt.t•:" () .-r.<·;~·] ~( l~an)o:'e• 111

propeller 1> r cotgttte - a' nutltncrltn th t- frClnt nf t in• bnnk. utu ler t he heildtttl!. " 1:'\~TR\'CT IO\'S FOR l!"F. Of l ii iS I. G ' · ALL D.\ T.\ otl u ~ t bear t he e otd•'r'cmen t of a cet t tftca t ... J mcchaott c, :we! ht• t<~ t tll l! an1l c~t tlltcate nunth(t tnu· t I.e •It"" 11

D.\ TE

19 ___ _

REMARKS Enter here l(eneral c:lata with reference tn "Line'' anc:l " Perinc:l1c·· lll•l'CCilnn ... - Rll!!:llllt ChanJ.:<' ' - .\ltel;otl"ll"' - - Re1•«11< - .on.J rhan)o(e- 111 propeller or enl(ine - a« nut ltned in the fron t nf thi -. bMk, tnHler the hea<hn~:t. "I :\STRtTT!O:\S FOR t'~F. OF 1 111 S LOG r.oo~-: .· · ALL D.-\T.\ must bear the endMo;ement o f a certificated mechanic. and hh 1 it llllloC and Ctrtlilca te nu111hn 111\l·t be -hoown.

Sk Harbor Air orf Northbrook Illinois

DATE DURATION ACCU MU LATE D

FLIGHT NATURE OF T OTA L SIGNATURE OF TO OF FLYING T IM E

19 FROM F LIGHT FLIGHT .L PILOT

D .\ 1 F.

19 ~ ') ~lD #£;~~.,...

The aircraft and/ or component identified below was repaired and inspected in accordance with current Civil Air Regulations and was found airworthy for return to service.

6 -(

Pertinent details of the repair are on file at:

AIRCRAFT PROPELLER SALES & SERVICE (Repair Station 2377)

I Sky Harbor Airport • Northbrook, Illinois I under work order No ........ ~.ig§ ......... Mfr ......... M9.9.~~J:~.Y. .............. l

Model No ...... .2A3a.C33 ........... Serial No ...... ..5913.7..5-..............•......

Iii Inspected D Blades Straightened D Reconditioned ~ Overhauled D Nicks removed and blades repainted ~Balanced D .Com.pli.e.d.mth . .A...D. Note 61-19-4.

I ..... Bla.de .. Ser.iaL.blos~ .. .Kl85B3.~-Kl9~4~-- . . .....................

Date ... M~!/9.~----·········· Signed.. Jt~X~- ..... l~Y?.'!:.'?.-15. ... • This form is to be made a permanent part of t a ircraft re ords.

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- - ~ I I I CARRY FORWARD THE TOTA L A CCUMULATED FLYING TIME TO THE TOP OF NEXT P AGE

D.\ TE

19 ~)

REMARKS Enter here ,:reneral data with reference tn " Line·· ~ncl " Per incl1c·· Jn -pcc·t1 n1h - RIJ.l'~l nll Ch.tlll!<'• - .\lte~..r, .. n, -- Rel':tll, - .• n.t 1 h<~n"e ' 111

propeller nr enj.!ine - il < nutlllled in t he fr(lnt nf till • bnt•k . under t llie heachnl!'. "1\"~TRlTTIO\"S FO R l ":'E OF lii iS LOG (!()() " · ·· AL L 11 .-\ TA mu<t bear the en<l•' l'<enlent of a cerll ficat?d mech<lnlc. ancl 111- JatJIIJ.( and n1tlilcare llU111her 111u -t lJe -h"" 11.

S6lo~ CoM PLI

DA TE

19

REMARKS Enter here g'eneral clata with refe rence tn "Line'' ;111cl "Perin<hc" an-pecll nn, - Rtl-!~1 11 1( Ch.lllt.:<'< - .\lteaat a""' - Repa11" - ·""' chanKe - an propeller nr en.~ri ne - a< nuthned in the front n l th" bnr•k. under t he heaclanl!'. " 1.\'ST Rl TT IO'\S F O R l 'SF. OF l iii S LOG r.ooJ-:." ALL DATA mu<t be-ar the e nd•'r<ement of a cea·t tficat«l mechanic. a nrl ha- altttnl( aod c" rtofac;11e numher ot >u-t Le ,Jt.," 11 .

100 hour Perledlc Airframe Inspection lubricated airframe per manufacturer's recommendat ions. Drained fuel sumps, serviced batteries, shimmy dampener, ~NJ).S~

wheel, brakes , conducted retraction check. Ins ection check list on ~f~ile~a~t~~~~~~~~~~~~~~~~~~~-~~~ -this age.nc ,

spected accor and was deter

card no. L~t.: ..

--- D .\ "I E

= 19

REMARKS Enter here gener:t l l'l:tt<l with refe ren c e tn " Line·• :tnd " Pe rinchc"' "' 'l'e c to nn, - Ril!f'lnJo!" Chan~:<'< - .\lte.:.r'""' - R ~t''"r"' - ·'"" ch;~n~e ' "' propeller or engine - <~• nutllJled in the front nl t hi, bnn k, under the head nur. " 1:"\ST Rt "CTIO.'\S F OR t "SE O F l il tS L OG l~O OJ-.: .· • ALL 11.-\T.\ muq be;~ r the e ncl•'r<e ment o f a ccrulic;~teJ tllech;~mc. ;~nd h" ·~tllt.l{ and c~• td•c<~te nu111h~r 111 11 - t l,e '""" 11 .

-

n.vr E n~J'"III, - tllof rfl:tll"t ' Ill

En ter here g-enera l <i :lta with . refe1:ence tn " Line'' and "Pe 11,.,d1c" lll• l•ecn nn• - ~~~~~~~ ~ .C!l.lll~_c• - .\lt~~·''"t"i: -;-11 1

c..; '1 OG r.oo f( .'' pro pelle r or ensnne - :~ < our hued 111 th t fronr nf t lu- bM•k. IIIHier the he:~rhna. " I:\ S IR l t 1 I 0:\ S FOR l · E ) · · ALL D.\ T..\ mu<.t bt'ar the e nd.,r<ement of a ce1tlf1catcd mecha111c, :1110 h.- 1ann" and retttltrare nu111her 11111-t l,e '""" 11

REMARKS

19

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19

DATE FLIGHT

FROM TO

NATURE OF FLIGHT

pURATION OF

FLIGHT 1!_

CARRY FORWARD THE TOTAL ACCUMU LATE D FLYING TIM E T O TH E TO P OF NEXT PAGE

ACC UM U LATE D T OTA L

FLYIN G TIM E SIGNATURE OF

PILOT

~/ It-- C" f

/ / .. ' , ,

REMARKS

JQ ___ _