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

INSTRUCTOR'S STATEMENT

I, as a certificated 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:

Transcription Notes:
Unsure about blanks and formatting with the words underneath the blanks.