# **ACFT N NUMBER \_\_\_\_\_\_\_\_\_\_ SQD NUMBER \_\_\_\_\_\_\_\_\_\_ MONTH \_\_\_\_\_\_\_\_\_\_ TRANSPONDER DUE Date \_\_\_\_\_\_\_**

# **LAST ANNUAL Date \_\_\_\_\_\_\_\_ 100 HOUR DUE Tach \_\_\_\_\_\_ 50 HR DUE Tach \_\_\_\_\_\_\_Date \_\_\_\_\_\_\_\_ ELT DUE Date \_\_\_\_\_\_\_ STATIC DUE Date \_\_\_\_\_\_\_**

<table style="width:100%;">
<colgroup>
<col style="width: 6%" />
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 19%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Date</td>
<td><h2 id="mission">Mission</h2>
<p>Number and<u>/or Symbol</u></p>
<h4 id="from-to">From / To</h4></td>
<td><h2 id="tach-stop">Tach Stop</h2>
<p><u>Start</u></p>
<h2 id="elapsed">Elapsed</h2></td>
<td><p>Hobbs</p>
<h2 id="stop">Stop</h2>
<p><u>Start</u></p>
<p>Elapsed</p></td>
<td><p>Hobbs</p>
<h2 id="total">Total</h2>
<p>Flight</p>
<p>Time</p></td>
<td><p>No.</p>
<p>of</p>
<p>Land-</p>
<p>ings</p></td>
<td><p>Oil</p>
<p>Level</p>
<p>Before</p>
<p>Flight</p></td>
<td><p>Oil</p>
<p>added</p></td>
<td>Gas Cost:</td>
<td>Bill to:</td>
<td>Personnel on Board</td>
<td><p>Releaser</p>
<h3 id="name">Name</h3></td>
</tr>
<tr class="even">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="odd">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td>Scn</td>
</tr>
<tr class="odd">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="even">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td>Scn</td>
</tr>
<tr class="even">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="odd">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td>Scn</td>
</tr>
<tr class="odd">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="even">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td>Scn</td>
</tr>
<tr class="even">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="odd">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td>Scn</td>
</tr>
<tr class="odd">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="even">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td>Scn</td>
</tr>
<tr class="even">
<td rowspan="3"></td>
<td rowspan="3">---------------</td>
<td></td>
<td></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td rowspan="3"></td>
<td>PIC</td>
<td rowspan="3"></td>
</tr>
<tr class="odd">
<td>-</td>
<td>-</td>
<td>Obs</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td>Scn</td>
</tr>
</tbody>
</table>

**Days Down For Maintenance \_\_\_\_\_\_\_\_\_\_\_\_\_\_ To
\_\_\_\_\_\_\_\_\_\_\_ Purpose:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
**

**IA WING Form 99 March 2006 To be used in corporate aircraft pAGE
\_\_\_\_ of \_\_\_\_\_**