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Statement of Hours Flown (This must be exact and verified by log books and official records)

|h) Name of Plane|Type of Plane|Hours Flown|Private, Commercial, or State Service|
|---|---|---|---|
|over 2000 Hrs.|on 55|Types-|ie. Model "B" Wright, JM-Curtiss "R"|
|De Haviland - T.M.|Scout - Martin|Bomber|- etc etc - including -| 
|5 types - Flying|Boats - 4|Types Hydro|- 3 - Under 20 H.P. Land Type|
 3 - [[strikethrough]] over [[/strikethrough]] Twin Motor|Types.|All Training|Planes and 8-Test Jobs of New Types|

i) Has applicant done cross country flying? Yes  Give details below. 

|Name of Plane|Type of Plane|Hours Flown|In what Localities?|
|---|---|---|---|
|From coast|To coast|and Canada|to Mexico in 15 Aviation|
|meets with|the same| ship|without damage of any kind| 
|and in 31 st|ates with|- J.N. Curtiss,|Laird Swallow, Weaver - "WACO"|

j) Has applicant ever done commercial flying? Yes. Give details below. 

|Name of Plane|Type of Plane|Hours Flown|In what localities?|
|---|---|---|---| 
|Curtiss|J.N.|Over 1000|Passenger Flights, cross |Laird|Swallow|Over 900|country trips + demonstration| 
|Weaver|Waco|Over 200|+ sales - U.S. 31 States

k) Has applicant ever been instructor? Civilian flying instructor, Navy + Army
l) If so, give name of field and hours flown as instructor Mimeola, Mt. Clemmens, Wilbur Wright, Rich, Field
m) Was applicant in active air service during the war? Flying instructor
n) If so, what squadron? Flying instructor

[[indent]]Statement of Accidents and Breakages

o) Date | Location | Cause | Type of Plane | Extent of Damage|
|---|---|---|---|---|
|March, 1920|Ohio|Fog-Sudden|Test-Racing Mono. |Wash out.|
|Fog came im| while [[crossed out]]circleing[[/crossed out]] circling|field - landed|in ditch on|edge of field|

p) Has applicant ever completed a regular course of aerial acrobatics? Yes -Instructe, ACR, 6 Months

q) If so, where and when? Waco

u) Has any plane operated by applicant been declined for insurance or has the insurance been cancelled? No.

r) Give names and present addresses of two licensed pilots for references - 
E,M, Laird - Wichita - Kansas -
Ed Stinson - Detroit

5. I hereby warrant the truth of the above statements and declare that I am in good health, of temperate habits, and that I have not withheld or misrepresented any information which is calculated to influence insurance companies as to the desirability of insuring any planes that I may be assigned or name to pilot.

6. Statement of physical examination made on ....... is furnished herewith.
N.B. Date of physical examination must be not more than 30 days prior to date of application

7. I enclose ....... for $7.50, the required registration fee.
Certified Check or Money Order
N.B. Make remittances payable to Underwriters' Laboratories, Inc. 

George E Weaver.
...............................
Signature of applicant.