Flight Plan Form

1 FixNameFollowing FixDepartureEnrouteDestinationAlternateC eiling, Visibility and PrecipitationReportedForecastActual (Z)Position of Fronts, Lows and HighsWEATHER LOGT urbulenceand Cloud TopsWinds AloftIcingand Freezing LevelNotes and NOTAMs3. Aircraft Type/Special Equipment5. DeparturePoint4. TrueAirspeed Knots2. AircraftIdentificationFLIGHT Departure TimeProposed (Z) 8. Route of Flight 9. Destination (Name of airport and city) 10. Est. Time EnrouteHoursMinutes 11. Remarks15. # Aboard 14. Pilot's Name, Address, Tel # & Aircraft Home Base 12. Fuel on board13. Alternate Airport(s)MinutesHours 16. Color of Aircraft 17. Destination Contact / Telephone (Optional)Position ReportCLOSE VFR Flight PLAN WITH _____ FSS ON ARRIVAL/X-No Transponder/T-Transponder with no altitude encoding capability/U-Transponder with altitude encoding capability/D-DME, no transponder/C-RNAV, transponder with no altitude encoding capability/W-RNAV, no transponder/G-Global Positioning System (GPS)/Global Navigation Satellite System (GNSS)

2 Equipped aircraft with ocianic, enrout, terminal, and GPS approach , transponder with no altitude encoding capability/A-DME, transponder with altitude encoding capability/R-RNAV, transponder with altitude encoding capabilitySpecial Equipment SuffixReport Conditions Aloft - Cloud Tops, Bases, Layers, Visibility, Turbulence, Haze, Ice, ThunderstormsAircraft ElevField ElevBlock InBlock / +RWCADir. / +WVar. Jeppesen Sanderson, Inc. 1974, 1977, 1982, 1989, 1993, 1996 55 Inverness Drive East, Englewood, CO 80112-5498 All Rights ReservedMU436183 HWindCheck Points(Fixes)Course(Route) & ATIS AdvisoriesNAVIGATION LOG NCeiling & VisibilityWindAltimeterApproachTASR unwayTime CheckDepartureDestinationAirport Frequencies NotesLog TimeTotals Flight Plan and Weather Log on Reverse Si