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ENGINE : MAINTENANCE RECORDS N6273V

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Page 1: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

ENGINE: MAINTENANCE

RECORDS

N6273V

Page 2: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

C"'1Dm Airmotjll~, Inc.'AA MFIIUAC1'&1lOM .oc"7'Q{

2702 N. SUJ::RIDAN PH. 918.836-&36'lUI .... Okll.. HUG

WAIIRAN'TV:

AI engmes retxJih by CUSlomA/rmIltiYe oller March I. 1997, are guaranleed 10be !reoJrom001001$10 mate,f<lJ endWOtkmanshlp, unde'normal uwand aenllce lorsix mon1hs 0(240 hours; whiCh."", occurs fI,st An BddlUOnalproraled wm'anty wlll.pply 10parts onlyto manulaclurorspubtl5l1od T B O. Acoessorieswlll beguaranloed by Ihe -. All parta_Iabortt>be ~ byC1ll1OmAi1notow pno<tI>~1 of _" Cra:tedcYlndltrs and ""","casM e>OOIUOQ(l hom eII..arran_..,1m$S • can be delefltined 1M!lheyeread.eclIesultollmprope< assembly lossof _or uMoIairc:rahclalmsW!ncI be~ Proriltlon 10be baMdon hoon logged. or 40 hOurs per month;wrm_IS grea!ef

Page 3: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

ENGINEMAINTENANCE RECORDS

LogNO.~

Aircraft RogiSlr.llon NO,.._LtJ:..oft,_.1._7......3....J'-- _

Engine Manufacturer LYCO"'li"JMOdel__b-=2:,(,. 0 ~F 11'1-("

Serial No L-- 2'711... ''-9'--''''3'''(;-'.1'1--'-- _Date Installed on aircrall D"'-D~-c..(.

Time Belween Overhauls (TBO) Hou,.

If used on multl~englneaircraft:

n Righio Fronl

o Lefto Roar

www.odloO.eompoeox 1359( SOUlHotO. NY 11971.0965

(631) 7/:60931'S1~~

fAX:. (631)1~

c--

Page 4: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

----------------~==~~---------------.Page- -

ENGltIBMAJOR OllBRIlAllLBDTO MAUUFACT!!R!!R$SPBCIPICATIONSTT__2058.8__ TSMOH__2.l__(&est run)Model__0-J60-P1A6__ S/N__ L-2961~-36A__The aircraft, airframe, AirCraft eo;loe. propeller, orappliance identified above was repaired and inspected ioacoordance with manufactures specifications and currentRegUlations of the Federal Aviation Agency and is approvedfor return to service. Pertinent details of the repairs areon file at this repair station under.Work order no.__ 19940__Date_JIprU 25, 2006__ Signed ~ £~.FAA CERTIFISD REPAIR STATION. DC2R763K.CUSTOM AIRMOTIVB, INC.2702 N. SHERIDAN, BLDG. BlVLSA, OK 741.15PH. (918)836-6836 PAX (918)836-9431

for

carburetor was also overhauled (see tag). Magnetos, ignition barness,spark plugs, oil filter, and fuel pump are new. This engine wasequipped witll ___YBW SUPERIOR MILLENNIUM STEEL PIN SL36006W-A20P __cylinders during this overhaul.AIRWORTHINESS DIRECTIVBS POR: TYPB CERTIFICATB NUMBBR E-286MODB~O-360-PlA6 __ S/N__ L-29619-36A__ 1I0#__19940__ TT__20S8.S __A.D.' MBTIICID OF CQMPLIANCB59-10-07 pIC/II;BAD PROPBR BAFPLES AND ASSOC. PARTS.64-16-05 C/W BY USB OP A NEW PIN LW-15472 PUMP.66-20-04 C/WJ USED CORRSCT GASKET II/ADAPTER.75-08-09 P!C/W (ALSO SRB AD#96-09-10) .87-10-06R1 N/A PER SIN OR THESE ROCKER ARMS.90-04-06R1 NIA PSR MODEL OR SIN.92-12-05 RIA TO THSSS NEW SL13444-1 PINS.95-07-01 N/A; USED NEW SL746H ROD BOLTS.95-26-02 N/A TO THIS ENGINB.96-09-10 C/W; USED SL18109&l8110 GEARS (05K19423·S EQUIV.).97-15-11 N/A TO THESE NBW SL13444-1 PINS_98-02-08 N/A; CONSTANT $PBBD PROP.98·11-11 H/A; CRANXSHAFT liASNOT SBm'TO NBJ.SON.04-10-14 C/W SB475C IN ITS ENTIRBTY.05-19-11 NIA TO THIS SBRVICBABLE CRANKSHAFT SIN V17870.05-26-10 NIA TO THESE SUPBRIOR MANUF. CYLINDBRS.06-06-~ ~ TO.TRIS :ERVICBABLB CRANKSHAFT SIN V17870.SIGNBD~' ~ POR eRS. DC2R763K ON __April 25, 2006__

SUB-TOTALS...oeg<f---+---t---f

TOTAlSoCalty IUI'Wl'IItIto ned PiCiO

Page 5: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

DATE tXSCA.IP I ()N Of! WDs:t1< PEHF~O-SIGNIJ\IAC & OFf4 i II"IC.ATE.NO. OF F'fJi9ON FEfiFDRMII\G WORK

tl.i.":kOIOf4¢:"'I\G....",

"'"TOTA.lSbouqw ...... d ,....... __

ENGINE LOGBOOK ENTRYDATE:TACH:TTE:SMOH:

oe/Q9~5423.12056.80.0

REG .: N6273VTYPE: C-172RG

'n$IQlled ly."",lng 0·.360-F1A6 Sin l,2961 ~36A on N827aV. Serv;"" with 8 Qual1$A""""ell100 Str.lgnt Mineral 011. Prop governor sent to Soutllwest Aoro for """maul and relnsUlKed.This engine hU been ran and leak ch""k O.K.

AulhO~t.d Signalur.: :sr;;._ ~4f /!ij) 2f1W'Y1Mwi. II 06-3322Wings of Wenatchee. Inc.

ENGINE LOGBOOK ENTRY

DATE:TACH:TTE:SMOH:

~ REG I: N6213V5423.1 TYPE: C-112RG_.r 2059 s">00

I ""rt~y this ENGINE nes been In"l'ecled lAW. WII1II' ofWenIlClle •• Inc.. ~at 72RG S.rt .. AAIP pna •• 4 InspeC1ion and determined to bOln .'rwoMy oondijion.

AulhorlZed Signature: ~ 6.u.a.e.tt- a;f$'/(II(7J? wlO' 0&-3375WlnO$ 01Wenolchee, Ino.

1

1----1----1----1 SUB·TOTALS thisOeaft

Page 6: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

DATE I ~'"..........

ac9QRIf'I tUN 01'W()~I<foItH"O"~(O-OONNuAt , Cl5'A'HICAJE NO. OF PEft9cw-. rt:AFOFiM ~ wom<

- --=--_._---==----------=::=::;t--""I

l1J1.11'T""....WI,.,,,I

ENGINE LOGBOOK ENTRY

0AT1:: 07ll'lOeTACH: 5471.6TT1:: 2107.3aMOH: OCJ.46.5

REG t: N6213VTYPE: C.l72RO

~lnltCl 01. R&R 1iIt ..... M __ CH4S111).1 ...... nd lmpoCIed, .. _ with e qlAllS PniIIips_ R"""" af'd _ """*OK.

I cet1l1y l1li1ENGINE bl. bean lrepeded lAW • WInO' or WOno!choO, I"",, Coosna112RG 1!iotI.. MIP PbHo 1 Inspectioo and douwmlnedl. be In alrwonhy oond.ion.

AUlhoiUOOSIQnalure:€l.. ,w91 iJ,/mj;;; M J""?1B<{ wlO * ~34()7 -Wingo 0'WOnat""ee, Inc.

- +

ENGINE LOGBOOK ENTRY

DATe:TACH:TTE:aMOH:

-~5OG.92144.0005.8

REO I: N6273VTYPE: C-172RG

0.• ..., ... RAR ... with ..... CH48111).1. CUIond ~ end_WItI> e quorI$PftiJIopI20w50. EngIne _ end _ c:N!d< OK

i>.~o,",ed oomp_ ""."" •• 'OIiOWO:" 7S1l10,11278180.1311180, ""9/80, a"" mastero~n""42.SPlJi< plugs cleened. g.ppea, t.... d, totaled and ' ..Milled

I_Itt 11111ENGINE '_ed lAW 1 WIi1gt 01WOna1Chee. 1110,.Ce$SNIl72RO S«Ios MJP P!IaM 2 '''"''"'' .... _ cIOCOn\'IInId ,. be In~ concfiion.

AuIhoNOd8ig...rur9.<3.''''I. I.!ktie. J,P3>'WAJ wlo' ~11WIi1gt 01WSnatchoO, Inc.

IT-

L

sua.TOTALS Itu, CIIQt

<-__ .1...__ ...L.__ ....J TOT.Al.lKoI1y _ .. -_

Page 7: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

DATE I '),CI.QP ,It~U IS!''"

.~. TOtALS bruuijllt to......tard from pNvloutJ I\l'ge-I,-- --------- --===---==-_=-----

II

ENGINE LOGBOOK ENTRY

DATE:TACH:TTE:SMOH:

0510212007557482210.515'.7

REG t: N6213VlYPE: C-172RG

Or.tr_ 0•• R&R"erwill> new ~I'G-l. cull""inspected old filer Ind seMc:ed wth 8~Phillips 2OW50. Engln. ",nup and I.a~ CIleCt< goOd.

CW SII C5 vacuum pump In.spectioo by visuallMpediOn for wear and found w;thln limits

I <OfIify this ENGINE nas been In"",Cled lAW. Wings of ~ntIId1.e. Inc.. CessI1a172RG $eti(lS AAIP Phase 3 InspecUon and d~ennined 10be in airworthy condition.

AuIJIorizedSIQna1uta: 4.. "tillw& AteWVtrtl wlo' 07-3816WInos ofWenatctle9, Inc.

- r---~~-------------------------------~-I

ENGINE LOGBOOK ENTRY

DATE:TACH:TTE:SMOH:

071031075807.32243.0184.2

REG t: N6273VlYPE: C-172RG

DraWId oil, R&R filer wilh n.... Ct-I4lIl1Q-" out and inspeeled old fi•• , and serviced with 8quarts Ph. 2Ow5O. Engine runup and leakc:IM!d< 01<.

Performod comp11>sslon<heck as foUows: " 78/60,112 78/60, 11318180, & 114n180.

Cleaned, Jnspoded. oepped. teSted._ed. Ind !e-lnstoUedspal1< pl"lIS·

Mag 10 .nglne timing checl<ed good .,25' !!'TOC.

ICI<1ify 1I1is ENGINE lias _ in$j)eCted lAW • WIIlQS ot Wen.I~. Inc.. Cessna172RG~ri••M1P Ph~ and delenrined 10be In "'_, concWon.

AulhOnzedSignature~ b/ZeEl'{tY! y w/o' 07·367,Voo'wIgS 01wenatchee. Inc.

rIIII

II_________ J

-,

SUB·TOTALS this pago

TOT~IIY torwara '0 nm pago

Page 8: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

"'"'N'•-..

DATE:TACli:rrs.SMOH:

t~ "'tt'''''''-",.- IltOO"Oh.... ...""........ ~

~Of:WOHM~0%A~ 4Ca;r~ll:. HQ_ Qf' PC:R:I()H pt"1V(IAt.,I1"i(j WC'JnK

TOTAUI __ """' __

=-...=-.=--- --'-='--_-

101O~J2007S6eV.723115 •24e e

0<1103120085712.12347.82a9.O

----,ENGINE LOGBOOK ENTRY

REO II: 1'm73VTYPE: C,'7ZRG

I-II

--- -----_._----- -----'

Otalned oil. II&R iii••w;\I1 new CH0481'(1.1, cul'neI inspected old " • .,.Ad .... Iced with 8I ....~_50.eng;no_"' __ OK.

I ICrilYths ENGINE.... bee>~ IAW.~oI_.1nC. CUIna1T2ftG $triaS !oNP ""- I .......... lOn.., deMt"""OO 10be in _"" -.

I AUI_ ~T>J" wkui tU~Atf 3<22YB/wto' 07-3739WIn;> 01Wo.. ch.. , Inc. l-

;:'=======E=N=GI=N::'E LOGBOOK E:R-Y ---- -l-I1-

0rIIned cI. R.&R ... willi ,_ CHoI811(1.1. CIA .., inIpecI coot ..... of fill"'" _ with8 qII. ~ 2OWo5OXIC EngN non UP'" ...... _ gaM

CIIe<* ",._ tinong 81W BTOC. OK

CIunCIIP- leSt -" plugs. R_ .....hnew _ gaskets

R&R IlIductlOllAirfill.,wilh now pan • SA 1180S

Pilrf_ CAlmproUIoo _ u1011.... : f1 751110It2 7511!O 13 75180 lOA 1~0.

DATE:TACH:rre-

r

IIEO ,:TYI'E:

J

I I ~ Illio ENGINE has IIee<lI_ctOO lAW • WIngs 01weflll1".,.". Inc •Caton.1T2ftG _ !oNP P!JDo 2 ~_......., _,_10 be in_~AJ.NtbtIzed~l!l!fMl)/~<:j( M'~t.jWifIOS 01W_Cllee, Inc.

1-

\- __ -1-__ +-_--1 SU8-lOTALS .. t:q!

TOTAUKa..., _"' __

Page 9: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

ENGINE LOGBOOK ENTRY

DATE:TACH:TTE:SMOH:

071101085774.92410.S351.8

REG .: N6273VTYPE: C-172RG

Dnlinod oil, R&R _WIll> new CH4811~ 1, "'" and onspedecl old. and seMc:ed wllll 8 qtsPhi,ps 2Ow5() Engln. ",nup and leak ""ecl<e<I ok

'certify ,,,.. ENGINE has been lnspec:Iod lAW a ~ or_. Inc.. CessN172RG Sen .. AAlP Ph ... 3 Inspection and _ned 10 be In aI.-thy OOndlion.

Authorized Sign.lu .... '51;;;:' 6v.v.4 ft,l'ZteYIW;;n- wIo. 07/10108WIngs oIWenslc:l1ee, Inc.

ENGINE LOGBOOK ENTRY

DAreTACH:TTE:SMOH:

oem/2OO85811.82'47.S388.7

REG I: N6273VTYPE: C-I T2RG

DnlIned engine, R&R fliler with newCH4811()'1, "" ano i_ct contents of D4dfill.r. serviCedwiln 8 qts phillips 2f1oIV5OXJC. Efljina nmup and leak _ OK.

Pefformed compression _ .. follows: 11 78180 11275180 ~ 75180 14 75180 Master orlllco44.

RAR ~ "" R .... WlIIl_eA 5805 elemo ru,

Chock magneto ~miil9at 25' BlOC. OK

Clean Gap and lest spall< plugs. Roinsl •• wiIh ,_ 1ole7' _ gWOIS.

I certiIy tIIis ENGINE has bOOn Inspeaod lAW I WIngs of WenaId1 .. , Inc., cessna172RGSenes MIP PII_. ,_ctlon and Gotormlnecl'. be in airwonhy CIOI1dDon_

A_s;gnowre:$ow/4d ~ ftif~l..fB1 wiD' ~3954_jIMngs of Wenalchee, I""

ENGINE LOGBOOK ENTRY

DATE:TACH:TTE:SMOH,

01107/095871.32507.044&.2

REG I#; N8273VTYPE; C-172RG

Dral ned 011,RAR flker wiIh new CH4811 0-1 , CUIand i_ClOG old llier Ind ..... ...., wiIh 8quw Phillips 2OWSOxl." engine",nup and lelk checl<od ok.

I oerllty this ENG,NE haS b_ If1SII8C!"" lAW a Wings of Wenatc:l1e., Inc:., Ceslna172RG Serl .. AA1P Ph .... 1 Inspection Ind determined 10 ba In olfWonhy condftlon,

Autho<!ZIId Signature: -cfu.-:« mez.aa'Ift/ ~ d wlo' ~WInOS d_ch6e, toe.

Page 10: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

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------IT . 'ISMOII--- ()<L 15. 20(19

W0¥216460-301HIA6 SI'oj L-296IY·36A

Tlli>cqgiD<- .. '" dilf.-tembicd Ml~ """"!lh ...f..u.wtean IllIenW m>peellon (no problems fuundJ-A,. J'I\"UU'''O~mc:osurc a1" <>bndm """" cleaned. ~ ",.-..1 ,01...baaed.nd ""'" rin" III (.umdArd SUlci bores),

Applicable fKll1.> "'<I" oleMed, inspected. reworked OJncces:s.lW) I.U ucc:rtaill alrA\udu:oc:..."'\,1\010:A.D.# Melhod vC<omph""""95-07-01 'oj//\ w O_n.:w SL74644 rod ""Iu04·10-14 CJW S1I47Sc.: ; Il"nf 1110d,msp. & retentien,OS-I9.'1 N'A (j) tba --.'<cahIesbafts. ...VI7a1O .06-06-16' ..06-12-07 NlA ~lthcJc Mill""",,,,,, cylindets .()6.:!0-09N'A .. Ibis oervi<caI>le sba(I Sin VI7K70 ..07-04-19 N//\ 10 0""" cyhnde~ by m.mu( d4l~.O&-J9-()51\!A l<llbcoo Millc:mrum cyrmde:s.

F.Jl8im: ...... """",mbled J JNW I,)'COmin8 o,crlwtl """'WlI116(1294-7·12, t•• 1 nm UI) • Oland nnd found ""'dy lor retum 10service. l'ertinott. dctaii~In: on file '1 ibis sCallon IItlCkTwod< order 111). 21646: P:II'" roplated an: Ii.led on,u'ocbc<I "od<~)M.......LQ' .MIIri< D. LJ.'1'''1 ('" C R7()3K.

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Page 11: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

DATE

'''''' .._".....,.."...

OCSCRIl7'nON QrWCRK f'OfTO~SIGSKl'\.IFE & crRTFJC.A"I"C NO OT P£RSOfJ PEi=L-c:cn.tN:; WCAt

ENGINE LOGBOOK ENTRY

DATE: 1012812009TACH: 5911.9TTE:SMOH:

REG t: NB273VTYPE: C'172RG

wIo' 09-<1074

ENGINE LOGBOOK ENTRY

DATE:TACH:TTE:SMOH:

1111111200115912.62548.$4811.5

REG .: N6273VTYPE: C-172RG

PerfOll!l~ _os r_11761SO#2 7518Of31!18O'" 75180.

Clean gap .... and ""ate "",,,, plugs.

R&R Indudion air lIIter wIIh .... oIement pert # SA 5805.

CfoN SHI SOOIlr.Starto< In.poetlon. NOJCIduo 5412.6

CfoN SHI SOOIlr.Maon",o InBPectlon. NOJCIdue 6412.6

, c;ol1ify Ul<sENGINE ha. be<!nInlpoctod lAW. WIngs or Won.ten." Inc., Co•• ne172RG Series AAIP Ph... 1" In.poetion and del8rmlned to boln al"""rthy cooditiOll.

AuthOrized Sionalure:;t- W"£,,, Alp 3bJ?'!eLf wlo. 09-4164'Mlg$ ofWe_e.mc.

ENGINE LOGBOOK ENTRY

DATE: 121021200IITACH: 51112.7TTE:SMOH:

R&R EaT Probe with .... Plrt 1I1!6255

A<rtIIorizedSignatunt: ~ ~ M3IWl-IeziWIrlgs "'_, Inc.

REO .: N6273VTYPE: O.172RG

wlo. 09-<1164

Page 12: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

OATE

mr ._

t

"".re..e£11,\':£

~~14"

DATE:TACH:TIE:SMOH:

ENGINE LOGBOOK ENTRY

021171201051119.82555.5498.7

REG " N6273VTYPE: C-172RG

Re"""'" engine 10<inspecIion and repair as needod oft propeller ground ~~~. d".ng gear""tanding. Englnewasslippod 10PremlefAlr<rell for _ and,"",,1r see -no log,oilY from Prtmle<.

Authorized Slglllllure: e:k....,(M IAI~Atf 3C,;;QHS'/ '111 wlO II 10-4221wenatchee Jet Center. Inc,

L-- -

---

---

+- --

- L

l

IACliCRIIr(:C;Ia:rI'\O oeSCRIPllO!-t OF WORK PERFOHMEG-~!"...i_' SIGNATI,rPGa CERTIFICATE NO·or PEnSON PFAroRMING wOFcK

__ 1 ~=I=rO'Als brougIlI_'rom .,.......-;;;'-If

I-ISUB·TOTALS """ I><g<

L __ -'- __ .....JI..... __ .J TOTALS-Car!)' forWArd to 'laxl Ptt08

Page 13: ENGINE : MAINTENANCE RECORDS2702N.SUJ::RIDAN PH. 918.836-&36 'lUI.... Okll.. HUG WAIIRAN'TV: AIengmes retxJihby CUSlomA/rmIltiYe oller March I. 1997,areguaranleed 10be!reo Jrom001001$10

DATEt:rr.o... I'':H ':fl",4 f€::cfC1l'.I.:.~'Ni:;t .....

~=t~ nE

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DtIMiript (10

GO.o4ettlorSMVke IntolmMjon~ SIJ~.'t511267(; PI,tenOln~Iug.S&l3;A Ccnrtc(iI'lOtod.S85~" PfOccller.:, ~..5824QU Repl*=.".. ..... pa~:IAkwonhlneu Dtrect"'"e..o;".I:P_....,..,_,0

O'SC~IPTION~ WOAt< PERFORt.!~SGNATURF 10 CFA"rFI(',.ATF NO OF P£R5ON PE.R70RMING YIORI<

!! ~N .,__,. ...-N 01 QIM!'C) g;.aI$

N PiSO\OfI pinsV ~l;s.~;,t t:Ofl'Osi()fl

" Nelso'l eranl:6t'l1I.1IS-y C.osnk &.. gsar

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