Part 45, page 24
FBI 164-81, Vault Part 45 p. 24 (DB Cooper-4647), Form, serial SR 380-160-1 (as read from the transcript) — cooper.theunsolved.net/parts/Cooper-Part-45/pages/24
Transcript
The scan is the source; the transcript is machine-generated from it.
43. FLYING STATUS AUTHORITY | DATE | RESTRICTIONS [blank rows]
44. RATINGS, SPECIALTIES, AND DESIGNATIONS RATING, SPECIALTY OR DESIGNATION | EFFECTIVE | AUTHORITY [blank rows]
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45. AIRPLANE QUALIFICATIONS (Military) NO. OF ENGINES | TYPE OF PLANE CONVENTIONAL: 1 / 2 / OVER 2 JET: 1 / 2 / OVER 2 OTHER: [all rows blank]
46. FLYING HOURS HOURS | MONTH AND YEAR 250 500 750 1000 1500 2000 3000 5000 [all rows blank]
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47. CIVILIAN FLYING EXPERIENCE (Nature, type equipment, no. hrs., last date flown, licenses) [blank]
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48. COMBAT DATA (AAF only) [blank]
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49. INTERNSHIP HOSPITAL (Location) | TYPE | TOTAL MONTHS | YEAR COMPLETED [blank rows]
50. PRIVATE PRACTICE LOCATION AND TYPE | % OF TIME | FROM TO [blank rows]
51. RESIDENCIES AND FELLOWSHIPS HOSPITAL (Location) | SERVICE | TOTAL MONTHS | YEAR COMPLETED [blank rows]
52. POSTGRADUATE INSTRUCTION INSTITUTION | COURSE | TOTAL MONTHS | YEAR COMPLETED [blank rows]
53. CERTIFIED BY AMERICAN BOARD OF | YEAR SUB SPECIALTY | YEAR LICENSE (Type) | STATE OR TERRITORY AND YEAR [all blank]
54. HOSPITAL AND TEACHING APPOINTMENTS INSTITUTION | TYPE | HOURS WEEKLY | DATES (From - to) [blank rows]
55. BOOKS AND TECHNICAL PAPERS PUBLISHED | YEAR [blank]
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56. PROFESSIONAL AND EDUCATIONAL SOCIETIES (with degree of membership) [blank]
57. COLOR HAIR [blank]
58. COLOR EYES [blank]
59. PHOTO [small photograph present]
60. COMPLEXION [blank]
61. BLOOD TYPE B011
62. SPECTACLES DATA [blank]
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63. AUTHENTICATING SIGNATURE. TYPED NAME, GRADE AND ARM OR SERVICE OF OFFICER AND DATE [handwritten signature: John P. List] 1st Lt, T C JOHN E. LIST, 1st Lt, TC PAGE 4 3Aug51
[stamp/print at bottom right:] DB,Cooper-4647 [small print:] U. S. GOVERNMENT PRINTING OFFICE [form number partially visible:] 16-61008-1