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Form ACA 347
(Rev. 7-15-41)

INSTRUCTOR'S STATEMENT

I, a Certified Instructor, certify that___________(Name of applicant)
an applicant for periodic endorsement of_____________
certificate has satisfactorily practiced and performed with me all maneuvers required in the flight test for original issuance of such certificate and has logged the following flight time under my supervision after_________________(Date)

Flight Time
[[5 Columned Table]]
DUAL HOURS | SOLO HOURS | TYPE | AIRPLANE CLASS AND HORSEPOWER RATING | IDENTIFICATION MARK
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---

__________________
(Signature of instructor)
__________________
(Certificate Number)

Date:________________

Remarks:

4462

Transcription Notes:
Unsure how to format the table in this document Use CAPITALS where shown.