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IMPORTANT: SPECIAL ATTENTION IS DIRECTED TO THE PROVISION OF SEC. 605 OF THE COMMUNICATIONS ACT OF 1934 FORBIDDING DISCLOSURE OF THE CONTENTS OR EXISTENCE OF COMMUNICATIONS EXCEPT AS PROVIDED BY LAW. 

SERVICE RECORD.

This is to certify that the holder of this license has served as radio operator under my orders during the period named.

[[7 Columned Table]]
| Ship or Other Station Name | Ship or Other Station Call Letters | Ship or Other Station Type(s) of Emission | Period |  Service (Satisfactory or Unsatisfactory) | Certified by Signature | Certified by Title (Station Licensee, Master, Manager, or Authorized Agent) | 
| --- | --- | --- | --- | --- | --- | --- |

|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |
|   |   |   | From  , 19  , To  , 19  , |   |   |   |

Transcription Notes:
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