FEDERAL AVIATION ADMINISTRATION

CERTIFICATE OF TRUE COPY

Y CERTIFY that the attached is a true copy of the complete airman file pertaining to
, date of birth May 11, 1975. Supporting documents are on file in the Airmen
ition Branch, Federal Aviation Administration, and I am the legal custodian thereof.

Signed and dated at Oklahoma City, Oklahoma

_ this 25th day of April. 2002 _

by Mae McGary

Supervisor, Certification Section C

(Title)
i****j
I HEREBY CERTIFY that Mae McGary

icdthl going certificate is now, and was, at the time of signing Supervisor, Certification
|C,the| :ustodian of the aforesaid records, and that full faith and credit should be given this
ate as sv

IN WITNESS WHEREOF, I have hereunto subscribed

my name and caused the seal of the U.S. Department of
Transportation to be affixed
this 25th day of April, 2002
at Oklahoma City, Oklahoma

(Signature)
Manager, Airmen Certification Branch
(Title)
Civil Aviation Registry
U. S. Department of Transportation
Foil : 2100.1 110.94)

NCTA000010956
 AI'IM.ICATION K)K RKPI.ACKME\rOH.OSTORDK.ST«OT.D
A I K M A N CKRTIFICATrXS) AM) K.VOWI.EIX.TTKST REPOHT(S)

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hMaat and (xiimrlxl rmplti«rn In itrfrrmknr
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fur Iht ('nmprthrmhr Alrwia miliort Sntrni fr^lSV ••<!• ••tiJrtf dftnitnfwti far «.mflliii

Type of Ccrtificalc(s)

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S^lv-' '"^"v'-•'-, Completi

NCTA000010957
 oTunvaiunT, >EKi*<.«vj>ncN«a>-nT«>To<
TEMfORARYAIRMAN [CERTIFJCATE
... _ »IAn ^•M^IABB AU

NCTA000010958
 -
TEMPORARY AIRMAN CERTJRCATC

NCTA000010959
 Air Ag«ncy*a Recommendation

Dealgnattd Examiner or Airman Certification RepraeentaUv* Report

Eviluator'* R*cord (UM For ATP Ritlna and/or Tvo» RaUngtl

• -.:

LEBANON PASSPORT
r«tnMD
J«t»5QS___

. . . - . . . - :

NCTA000010961
 n 1 1 4
rvpf OK PRINT ALL EMfflES IN INK

Airman Certificate and/or Rating Application

ADDITIONAL ADDRESS INFORMATION

Nartw (Latt. Pint MMdto) JARRAH. ZIAD NMN.
SocM Security Numbtr
CarWtart* Number
MtelMIMd

Ptmtiwnt MtllfoQ Addn**

' U.S.

StIMt HANSASTR40
P.O.BOX 20144 HAMBURG
ON. 8Urt«. Zk Cod< GERMANY

• '•.:. >-••> ~ ^ ' f - '.ui^p:^ "v r/^-vr.CBMiv*"- >*

-
Mdn»» Hit toeUcint nauntt th» c«rt/«c«f» IM M<if to;

U.S.
SttMt
P.O.Box
Otv. 8M«. Zip Code

PhVfictl Dtteription M tnfwnd:

' • • - - .-•.'.; •;; f.-^SjUA-*-*

••.j':.$-~-.--',K&&sf&vx
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LaserGrade
YOUR COMPUTER TESTING SPECIALIST

••;. 800-211-2753'Box84245. Vancouver. Washington98684• www.lasergrade.com

Federal Aviation Administration

Airman Computer Test Report.. ;
EXAM TITLE: Instrument Rating Airplane (IRA) ..
NAME: JARRAH ZIAD SAMIR
ID NUMBER: B05111975 TAKE: 2
DATE: 11/10/2000 SCORE: 73 GRADE:-

ingle code may represent

A20 BIO 105 108 125 128 J01 J14 J35 \

EXPIRATION DATE: 11/30/2002 . . . . •..•.. .., . , -.-,,..f

DO NOT LOSE THIS REPORT-^M

Last name_
(Print clearly)

Signature

LaaerGrade Computer Testing

P O Box 87245
Vancouver, WA 98687-7245
800-211-2754 or 360-895-9111
www.lasergrade.com

NCTA000010963
NCTA000010964
TYPE OR PRWr XtL ENTRIES IN INK form Apprev-d OMB No: 21200021
Airman Certificate and/or
Rating Application
Ft«*ral AvUOgn Mmmnmaon

I Application MormaOnn | ] Student | ) Reeretttorwl [X)Prtvata [ ] Commercial ( | AJrtha Tianaport I ]

AdeWonal Aircraft Rrtrvg [X I .Anplarw 3>ngl«-Eiiglrw I | Atrplam MuHengtna ( ] Rotorcnft [ 1 GMer | J UgMor-Than-Ali
j ftyv Iratructor [ | Initial ( ] Renewal [ ) RerWa'ament [ ] AddKkmal Instructor RaOng ' . ( ] Ground Inatructor
j 1 Meetcal Fbgnt Tm I ] Renamination j j Reaauann of C«roncata O«Mr '

A. N*n» iLtt. Fm. Mxu»j C. OdtoTBMl

Mo. Day Yur
09/11/1975
t Addrau (flfftf Sf» mtniaan tWor» CaaflMingi r. Niooiumy (cnzvnMp) tBMlty a Do you read, tptak, and
MANSA STR «0 1 U1A [ X ) 00m LEBANON underabxid tngrWiT | J
20144 HAMBURG
GERMANY

M, 00 you now IMd. ar Iwv* you «VW htH m FAA PHol CartMCJlMf N. Ontf* P*X Cvmail*
YM (X I No

t,OMaluu»d
07/11/2000

a Mam you bam canvfeM for vtoMon or Feaaral or Slalt itiium rataong * luroote orugt. man)uana. or tiomunt '. - • . :^-'
,or»fanuUiitdni«ior»UB>lanc«T . ;. . . • ' [ ] Y*> ...i->.(X ] No"«

/ naw notoiann•nyafcra' a»)act anteft niiKi'

I Caitffiula or RaUng ApplM For on B«*l» of-

[XI XCompMloaot
««t

koura aa pool In cemm«

dMjtavtJIJ inontfM ta Kia^TCiAovrtnQ KMMary aJroraA
1. N*ma and lacaaan o» Trakang Aoanay or TraMng C«Mar

[ .] C-CompkOengfAIr

• RaeortofWWBma

Ft Tlma-AI Catagortet Total SoloAJrplaiMToW

F» Tlm»-AI Calagorlea BgM Inttn SotoAirptanaCroiaCoun*y
FR Tim* - AI Catagortoi Solo SotoAaph*Ftgbi(150 nnV3 landhflpteJ
Mn Akptana Ctoaa Counfry SoloAtrptanaTOfl.• '

lOOnm
IraoiAfplmaNlghlTOA.
Inatt) AJrplam liwtrumant
lnattiAJn>t<Hft>iPrei)MOav»PrlofiT

V. ApoHcanfi Cartfleatton I oartirV thai al ttatamanbi and lad by ma on W. appfcaaon farm an oornparta andtua to tiabaatof ray
aHM fttu •!•» VatMrabtno VM Prtwcy Act
»at accomparaM Mi form
 9 0 !
Instructor's Recommendation
I have pcnwnslry imjrocted tie applicant and consider jtiji penon ready to take the teat.
6a« j Instructor-\t ~ ] Certirkaie No:, "" ' ~7 Certificate ExpVes ~
08/04/7000 ! ANKE HEIDECKE _ | _ _2S9«659CFI ] 05/31(2002
Air Agency's Recommendation
TNt applicant hat succetsfuOy completed our COUTM. and la
racommeoded fof certification or mting without furtrwir

Dale Agency Name nn4 Numb** ! Officiate Signature

I rai'
Designated Examiner's Report
[ | Srudenl Plot CertnVaie Itaiied /Co/if aitudml}
[x j 1 have personally reviewed thtt applicant'e pact logtooh. and certify that Ihe Individual mteti tfie perttncnt requirements of FAR 61 for the piol
cemftcata or rating aought.
[ } I have peraonaffy reviewed thia A[ipBcint'> graduation certificate, and found it to be appropriate and in order, and have returned Bw certrfcate.
j X I I have penonaty tented and/or verified Inn. appHcam in accordance wrih yertnent procedui ea and atandarda wWi tie reault Indicated below.
[X | Approved - Temporary Ceinfkato laeued (Copy AHachatl)
[ j Disapproved - D*a«pproval Notice Ittued
Tail^typ* ' Locaton of Toil (Facility. City. Slnlo>
Oral VENICE. Ft
Simulator
Tralnng Device I
.«** . . , VENICE, FL
Certkate or Ruing for Which Taated Tipe(.')ofAJra au*«v— Trti^
Private _ .ASEi, ^— .Initial CE-152 __ | ros
T M> Typo' " :Date ' Enmnar'a Signature ) ' rc'emfican Isio.
Oral i 0*T»«000 ; WHITMAN pXviD s /
I T O7"
TiatHng Onwe
5iosCiX5f.->^^2rt
Evaliiator's Record For Airline Transport Certificate/Rating Only
Inepcctor Eumlnar Data
Oral 1 1 1 1
Appravad Slmulalor/Trwnlng Ofivkn Check ( ) | )
Aircraft Fight Check j j j )
Advanced OualVaOon Program j ) | j

Inspector's Report
I have pcraonaly tattttj mta applcant hi accordance with or have ottorvrte vtrrted rot M* ippacant comptn with partkwt prooeduret, atandarda,
eotcln, and or necaaaary requkementi wiffi Oe raatil InoVatM below
t _t Approved - Temporary CartVat* laauad -Jfaapproval NoOoalaauea'
Teat Type' ' " ! 'Location" of Teat (FocHfy. Cty. Slolt) ~6urat>oneTTaat
Or.1 j Ground H5«
Simulator |
Tralrang Device
.._.... . - .
CarMotn Of Rait g tor Which Tetted I ~Typ«(ijorA»israfil)i»d TRagbniionNoXa)

j cSflftcale'or SaSg aaUB Mi "

I 1 Examtnat't RaconimandaMn MiHary Competence ( 1 Renewal | | Approved
( 1 ACCEPTED 1 ! REJECTED | Foreign (jcera* [ | Relmuiarne.it ( ] DaMpproved
( ) Rafeau* or Exchange of Piol Cartfflcaja ] Approved Cour»e Graduate Irutrudor Renewal IUa«d on
t 1 Special made* (a«t conducted • report forwarded ) Other Approved FAA OualificaBor CrSerta | ) Acflvtly ( ] TntangCourae
to Aaromedtcal CarBflcaBon Branch. AAM-110 ) Cam«cata (eaua<t I j AcquaManc* [ ) Teat
j Canfleala Darted __ ___
Tralrang Cour»T(FIRCj Rama " " ' "jOnduaion Certftcirie No. Data

ineipector't Slgnatura '

Oral
Slmulatar
TraHneDevka
Fight
Other ISJgnofp
Attachments:
f J Student Plot Cartfieata (copy) [X [ Airmam IdenMcaOon (ID) [ t Nofcao«0teavmo«al
[ X ) Report Of WrAanExamlnaten LEBANON PASSPORT [ I 8up*rMdedPMCattMca*a
[ X J Temporary Pfot Certfteete (copy) Form ol iO" I | Anawar Sheet Graded
( 1 Anew*/Sheet Gts<M
Number (Fcnign la^uiiiaK)
03/07/2005
m
~m
ACRA Equlv«le>nt ( JARRAH. ZAD
m

NCTA000010966
--.' TYPE OR PR/WT ALL EWTWES IN INK
Airman Certificate and/or
Rating Application

ADDITIONAL ADDRESS INFORMATION • ;

jN«m« (L»«t, Brat, Mlddla)

iSocW Security Number
.fCertfflctw Numbw . -
'O«t« li*ut<t v.;--'...''I.- •'•

P*rm«n«n( Hulling Addret*

•tfis*--^. >w-.y-^-:.-'• "':

•5^^a<A^x*'^^:/-;
^4%"-Ki;vS-v >*."&£.'' '.' '> '•• -:
tt>» tppllciint nqu*»t» th« c*rt/We»f» J^t m/>( to

NCTA000010967
NCTA000010968
 Instructor'! Recommendation
1 n.ive personally instructed !he apnlir. wit and consider Inis person ready to lake tr* test

lnsi Certificate No. i Certif-cato Expires

A.K
Air Agency's Recommendation
The applicant nas successfully ccompleted 01^ a. and is
fiXomnicndnd fof certification or rnting withuul
Aguitcy N^nMi antl Mumber OtticiaVs

Title

Designated Examiner's Report . . . . . .•-.:.••,.'*•

D SluOont Piioi CcMilic.no IssuL-d fCopy auachetti
K 1 hrwe personally reviewed this applicants pilot lognook. and cc-nty mat me Individual meals tho pertinent requirements ol FAR 61 for.tho pilot
certificate o* rating sought. '
. /

.--..- . • - - . »*,-:.r*- :
Q 1 navo personally reviewed this applicant's graduation certificate. n d found it to bo appropriate and in order, and have returned the certificate. : ' ." .u..
«
18 i havo porsonnlly tested and/or vcrtilicd Ihta applicant in accordance with pertinent procedures and standards with the result indicated betow. '^*"t\"^

•
ik^ • • •- •• . ••'• _': -it.''i'. • •••^•^"Ti- >7V '••":'
pr Approved— Temporary Certificate Issued Copy Aitachoti) - -;. " .. .,••--:...-..: .^ ::. fi':..':^~ic
D OisnpproveO— Disoppfovnl Notice Issued 'Copy/»fracft«d) • • ' - '
LOCilion ol Ttsl Iftcilily. City. Sltlttt
Ground :: Simulator..', ".^.Fright "
' '
Cartiteale or Rating lor Which firttcd Type(s) ol Aircraft Used Registration No.(s) -iieii
- '
Oat« Exominor's Sigruuuro Cenillcata No. — Designation No.. Designation; Expires -^
'

Evaluator's Record For Airline Transport Certltlcate/Rating Only.^.i^Sy^tSsS^V?

Inspector E>ammer ' Signature . • '.-.;••'-,•<,,? .'•'*?. fc'.JDttt^fig'Z'jfi
Oral
Approved Simulator/Training Device Chock
°
D
D
n
—r-.—.. . •' '.Vf.:::.: •^^••^v.^g
Aircraft Right Check : , a a
Advanced Qualilicallon Program
Inspector's Report ; - • - . • • • • . - ••.-.- ; c;i^fv;.. ,
1 riavo personally lusted this ipplicflnt In rnxordnnco with or havo athonviso voiitiort thai thli applicant complies with pertinent procedures; standards, 7":-':
policies. «n<J of nocsaanry roquiramentai with the result indicated balow. . .. ... ; :'•- ;. '.'... :;-V.:!l:
D Approved- Tarr.oor,iry Corti'icatB iwued D Olupprovcd— Disapproval Nolle* Issued ' "y"">""!:" :_^''fi^'
locution ol Tail (FtcUily. City, State 1 . Duration of Test v| •"•. '?"V:5J!v.K
- Ground ,.. - .-^Smulator ,j .'xiiBii

Cerulicata or Rating for Which Tasted Typo(s) ol Aircraft Used

D Student Pilot Certificate Issued •• O Certificate o> Rating Based on

0[ Ertmlner-i Recomrri»nd*t(bn .":•;••' :j D Military Competence
•S-O ACCEPTED..D.BEJECTEDX;: D ForeignL^nse "•'-' '" " D ReiratateVi^tV-D^^pproyedl
D Reissue or Exchange of Pilot Certificate D Approved Course Graduate Instructor Renewal 8«wd on . . _ , , . ; - • , „ «
D Special medical test conducted—retort forwardoa D Other Aporoved FAA Qualification Criteria C Aclivity • • - D Training Course
to Aeromedical Certificate Branch. AAM-,30 D Certificate Issued D Acquaintance D.f<x<" 1'^
a
framing Course (FIRC) Name G'aciuation CcrtiiicaieNo Date

Dole Inspector s Signauu FAA DiStrictOmc* >.r«

''; :T. • . ^"r .J -<, >i->i'v

Attachments:
D Student Pilot Certificate (copy) - ] . Airman: Identification (IO)
f? Report of Written Examination ' • •-' '.'•-'.'i'fj.-.'.-.O Si^rs^ed'i5iotCi»rtifciiei!f
- QjjTemporary P'kM C«rtificat» (copy) -"

>AA Form IT10-1 _(7-M) tvtuuanPnjvieuteameri $'?:.~~7;?y" ". 3-.?':'*^:feS>>S^

•>^ni-£'2y'":^P3«'WS££'-5'^i^^
 ! O

yOUR COMPUTER TESTINO SPECIALIST

-?I (•JJ7/5.1 • Dor 042-15, ViMcnuvni. Wi\*lunQlon QM',M • www.lnncigrnda.cOfn

-VSl

Federal Aviation Administration

Airman Computer Test Report
EXAM TITLE: Private Pilot Airplane (PAR)
NAME: JARRAH ZIAD SAMIR 50080120004648473 ;^fcfc^.^
••;•:••. -.•:i:"--^^Lr---^ff^i^-^
ID NUMBER: B05111975 TAKE: 1
DATE: 08/01/2000 SCORE: 83' .,'-, ,:.;GRAp.E: VPASS.^:&&£^?j$l

Knowledge area codes in which questions

See appropriate Advisory Circular —' '
available via the internet:
-http-:y/a£s600'. f aa .•gov/data/advTsoi
,A single code may represent more '
B09 H308 H316 H317 H340 121 125 131 158

EXPIRATION DATE: 00/31/2002 • =v • '"• -^~;^*&%$y$$$ --S

DO NOT LOSE THIS REPORT
Authorized instructor's statement. (If applicable)
I have given Mr./Ma. additional

/.. V- .' ':--^^iXi^^ii^Sim

Signature ^
-—— ':,^-msm^$m^
. • ''\ •''7''%??*^&^:$ffl
•
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':'."'.':' •:':;v''"r?~''1< •.."•.'!:.-?'-^."-'''-'."';.;?-fS|

Applicant Locator:! _JAPA0239 ',-.;;••.'.

LaserGrade Computer Testing Testing provided by::IAS34201-* JS
P O Box 87245 Florida Flight .Training. Center • >-:"; ?
Vancouver, WA 98687-7245 •ISO Airnort Avenue^•:a:..:.jAv:-i^':«•;"-;.:•'
800-211-2754 or 360-896-9111
www.lasergrade.com

NCTA000010970
 DEPARTMENT OF TRANSPORTATION

CERTIFICATE OF TRUE COPY

I HEREBY CERTIFY that the attached is a true copy of the original

medical record of ZIAD JARRAH dated July 11, 2000,

i file in the Aerospace Medical Certification Division

[ that I am the legal custodian thereof.
Signed and dated at Oklahoma City, Oklahoma

this 25th day of April, 2002

by JERRY K BOWEN
Supervisor, Medical Records Section
Aerospace Medical Certification Division
(fiikj
Civil Aerospace Medical Institute

**************************************************************************************

I HEREBY CERTIFY that JERRY K BOWEN

d the foregoing certificate is now, and was, at the time of signing

;ustodian of the aforesaid records,

1 faith and credit should be given his certificate as such.

IN WITNESS WHEREOF, I have hereunto subscribed

my name and caused the seal of the Department of

Transportation to be affixed this 25th

day of April, 2002

at Oklahoma City, Oklahoma

WARREN S. SILBERMAN, P.O., M.P.K '

(Signature)

Manager, Aerospace Medical Certification Division

(Title)

Civil Aerospace Medical Institute

Department of Transportation

Form 1 (9-69)

NCTA000010971
 Complete ALL
tdArM3> PLEASE 2. Claaa o( MjdtcaJ Certificate AppifefFor
fP*<st D Znd Q 3«j

4. Social Security Number

to. Type of A/rman CertfBcate<s| You Hold:

«lNona CJ ATC Specialist D Flight Instructor D Recreational
C? Airline Transport O Right Engineer d Private D Other
O Commercial D Flight Navigator D Student

3. Haa Your FAA Airman Medkeai Certificate Ever Bern OK**. Suspended, or Revoked 7
D Yet H No If ye». gr« date
'
Total Pilot Time (CKntan Only) 1«. Date of La»t FAA Medical Application
14.TeData

J-a. Oo Yo« Currently Ute Any Medication (Preacrlptlon or Konpr»»cr)p«on)7

4. No D YM (IT yea. below tat medication(s) used and ctwck appropriate box).

T.D. Do YOU Ever Uie Near Vlalon Contact LenajMlWiaap^nfl?-"^ Q Yea

18. Medical History - HAVt YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH, HAD, OR OO YOU PRESENTLY HAVE ANTOF THE F< S?: Answer Ve»" or 'nor
tor every condition listed betow. In the EXPLANATIONS box below, you may note "PREVIOUSLY REPORTEQJNO ~~ " >of«wcondibonw»s
reported on a previous application «or an ain B end (here has been no change in your condition;,; See IneO
Me CondrCon Ye« Yea No 'CondMoo
H Frequent or tevere headaches 9-D B Heart or vaacUartroubte gjj*»acy medical dMcharge
01 Ouzlneu or (Writing ipeU ^ Hferi or kw blood prewure B. Substancefependanc*or failed a Q Medical nsjectwn by notary service
*1? T* OHM iMfauertK
•-•
satatano abuse
to the
c-D ^ Unconadouaneaa ror any reason Stomach, liver, or V yam. pg Rejection tor *• or health Insurance
B Eye or vision trouble except glasses I-D (1 KMney stone Of Wgodjn urine-\e oratxise U.D ^Adrruslon to hospital
P. Hay rever or allergy k.0 iuidde attempt x-D illness, disability, or surgery
r.Q [p^Asthma or lung disease SlMotion sidviess requiring medication
Conviction and/or Admtnlatratlve>Ae8Bn Ht«tti»y----S»» Instructions Page
Yea]
n ttx History of (1) any!cenvicUon(s) Mvprvfeo dfwfeg while intoxicated by, while impaired by. or while under the History of nontraffic
r tnfluencerjjf.alcofXil or a drug; ipr<2):h6»tory- of any eonviction(s) or administrative action(s) involving an conviction(s)
-— * ':*> iresuted irfcthe^OehTaf. suspension, cancenatian. or revocation of driving privileges or (misdemeanors or felonies).
in attendance at an educational or a rehabilitation program.
FOR FAA USE

19. Visit* to Health Professional Within Last 3 Years. D Yes (Explain Below) Se« Instruction* Page
Date Name. AddreM. and Type cf Health Professional Consulted Reason

— NOTICE — 20. Applicants National Driver Register and Certifying Declaration*

Wnoever In any matter vAMn the
juiisdidion of any department or
agency of the United States
knowingly and wititulty falsWes,
conceals or covers up by any trick.
ccheme. or device a material fact,
*no makes any false, fictitious
_, fraudulent statements or
mpresentaflcns, or entry, may Be
lined up to $250,000 or imprisoned
not more than 5 years, or both.
I hereby authorize *>« National Driver Register (NOR), through a designated State Department of Motor Vehidee. to tumsn D the FAA
information pertaining to my driving record. This consent commutes authorizatton tor • aingl* wxeu to«« WonneBon contained in 9* NDfl to
verify information provided in Ihis application. Upon my request, the FAA shall mane the Information received from the NOR, if any. cvaUaMe far
my review and written comment Authority: 23 U.S. Code 401. Note.
MOTE: ALL persons using this form must sign «. NOR consent however, does not apply untesa this form le ueed aa an
application for Medical Certificate or Medical Certificate and Student Pilot Certificate.
I hwebw certttv that all statements and answers provided Oy T« on Uiis application form are complete and (rue to the best of my Knowledge, and I
asreethat»ey are to be considered part of the basis for issuance of any FAA certificate us me. I have also read and understand the Privacy Act
statement mat accompanies mis form. •_
Data, // fQJ-f
I O D / V Y YY

FAA Form 8500-8 (3-98) Supersedes Previous Edition

NCTA000010972
 NOTE; FAA/Qriginal Copy of tha Report of Medical ExaminatlqfrMust ba TYPEn
REPORT Of MEDICAL EXAMINATION
23. Weight (pounds) 23.StatMMntofO*i»oni«ralM>AblH|y(SOOA)
DYES - Duo c<K»Mot»*
CHECK EACH ITEM IN APPROPRIATE COLUMN. CHECK EACH ITEM IN APPROPRIATE COLUMN
25. Head, face, neck, and scalp 37. Vascular aystem npBm>»i«ia etmnatr. m*.
26. Nose 38. Abdomen and viscera (induaino mm
27. Sinuses, 39. AnU5
28. Moum and thro'al 40. Skin
29. Ears, general ilni«tiil»ii)«rt»m«le«n«lKft«arinaun<l«fi»m 49) 41. 6-U »y«tam
30. Ear Drunn jpytomion) 42. Upper and tower extremities (Sung* «x> »r^»
31. Eyte. general ivi«ienund«r««»i» to«>»v A3. Spine, other mmcutoslceletal
32. Ophthalmoscopic . 44. Identifying body marks, scars, tattoos (gin*
33. PUpll» (Equiny md mate") 45. Lymphattca
m. unaM. owiW n*n
34. Ocular motlllty (
35. Lungs and chest (MM inaxanq t»«»* «««min«t«»v) 47. Psychiatric lApoMnm* b«ti»»lcr. meet. eammunJoUon md imoiay)
38. Heart (P , »d munm*m) ^ . General systemic
NOTES: Describe every abnormality in detail. Enter applicable item number before each comment Use additional sheets If necessary and attach to this form.

49. Hearing Nnml Audknmrie SpMth

Right Ear ten Ear
Camaatfonal Audiometer 500 1000 2000 3000 4000 500 1000 2000 3000 4000
VofceTMlateFMt •
D Pata D FaH
M. Distant VUton S1.a. N«»rVT»Ioo Sl.b. intennedlato Vision - 32 Inchee C2.Color VUton
Right 201 Corrected to 2DI Right 201 Corrected to 201 Right 207 Corrected to 301 D Pass
L»n 2CU Corrected to 201 Left 201 Correctedto20/ Ufl 301 Corrected to 207 O Fait .
Both 201 Corrected to 201 Both 20/ Corrected to 20/ Both 201 Corrected to 2<V
S3. Field of VTalon J 54. Heteropnorla 21T on prm, dcow.) Eaophoria Exopriorta Right Hyperphoria Left Hyperphoria
P ^ormal D Abnormal
oodPraesure S«.Puiee 57. UrtnaJvvJa or abnormal, ghensutts) 68. ECO (Patt>
,«,„ I Systolic 1 Dtestoflc Albumin
(SMang. . • • - - - - - -- Sugar M M I DO I YYYY
mmorMwcuty) I O Normal D Abnormal
St. Other Ti

60. Conunecit* on History and Findings; AME shall comment on all "YES* answers In (he Medical History section and fof FOR FAX USE
abnormal findings of the examination. (Attach all conauttatlon reports. ECGs, X-rays, etc. to this report before malfing.)

Significant Medical History O YES OHO

" • _ Abnonnal Physical Findings
>-i»*iy»»ii«»»-»-uyot^<H ringing* D
i—iYES
TCJ • u no * -"
OHO
S2. Has Been Issued- O Medical CerStote ^^Medkal & Student P.tot Certfficato
U No Certificate Issued —Deferred for Further Evaluation
n Has Been Denied — Letter of Denial Issued (Copy Attached)
;l Disqualifying Defects (List by.9ani.mim.pcr).

ata of Examination
.tg-aaga,^^
Aviation Medical Examiner's Name " ".
Aviation Medical Examiner's Signature
M M | D O | Y Y YY Street Address
AME Serial Number

, Form 85004 (3-M) SupeiMdw Pntviou* Edition

HSN: OO52-00-870-800a

NCTA000010973
 J"
200000251458 Appl. ID: 1999247521 1. Appl. for 0 Airman Med. Cert. [X] Airman Med. and Student Pilot Cert.
of med. Cert. Applied [X]1stQ2ndQ3rd 3. Last: JARRAH FifSt: ZIAD Middle: 4. SSN: 888-00-7106
5. 1..J-: 4641 BOUGAINVILLA DR City LAUD BY SEA St: FL/Cou.:USA Zip: 33308-3616 Tel.:
6. DOB: 05/11/1975 Citizenship: 7. HairClr,: BLONDE 8. EyeClr: GREEN 9. Sex: male
10. Type of Airman Certificate(s) You Hold: [X] None 0 Student D Other
rj Airline Transport D ATC Specialist f] Flight Instructor [] Recreational
U Commercial Q Flight Navigator D Flight Engineer [J Private
11. Occupation: STUDENT 12. Employer.
13. Has Your FAA Airman Medical Certificate Ever Been Denied. Suspended, or revoked? uYes|X]No If yes, give Date:
Total Pilot Time (Civilian Only) 14. To Date: 11.6 15. Past 6 months: 11.6 16. Last FAA Med. App Date: [X] No Prior App.
17.a. Do You Currently Use Any Meds. (Prescription or Nonprescription)? [X]NoQYes (If yes. list medication(s) used below.) Prev Reported

17.b Do You Ever Use Near Vision Contact Lens(es) While Flying? QYes[X]No
18. Medical History - HAVE YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH. HAD, OR DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING?
Answer •yes" or "no" for every condition listed below. In the EXPLANATIONS box below, you may note 'PREVIOUSLY REPORTED. NO CHANGE' only if
the explanation of the condition was reported on a previous application for an airman medical certificate and there has been no change in your condition.
Condition Yes Condition Yes Condition Yes Condition Yes
a Frequent or severe headaches D g Heart or vascular D m Mental disorders of any sort; Q r Military medical Q
b Dizziness or fainting spell 0 h High or low blood D n Substance dependence or failed Q s Medical rejection by D
c Unconsciousness for any Q i Stomach, liver, or D o Alcohol dependence or abuse Q t Rejection for life or a
d Eye or vision trouble, except 0 j Kidney stone or Q p Suicide attempt Q u Admission to hospital Q
e Hay fever or allergy D k Diabetes D q Motion sickness requiring rj x Other illness, or D
f Asthma or lung diseases 0 I Neurological disorders. epilep: D
Conviction and/or Administrative Action History Yes
v History of (1) any conviction(s) involving driving while intoxicated by, while impaired by. or while under the influence of alcohol or a drug; or (2) D
history of any conviction(s) or administrative action(s) involving an offense(s) which resulted in the denial, suspension, cancellation, or revocation of
driving privileges or which resulted in attendance at an educational or a rehabilitation program.

w Non-traffic conviction(s) (misdemeanors or felonies).

Explanations:

Visits to Heallti Professional Within Last 3 Years

te Name Street City St Zip Country Type Reason

20 Applicant's National Driver Register and Certifying Declarations: Date: 07/11/2000

REPORT OF MEDICAL EXAMINATION
21. Height (Inches) 22. Weight (Ibs) 23. Statement ol Demonstrated Ability (SODA) 24. SODA Serial Number
70 174 IblSOOA
Check Each Item in Appropriate Column Abnorm / Norm Check Each Item in Appropriate Column Abnorm / Norm
25 Head. Face, Neck, and Scalp X 37. Vascular system X
26 Nose X 38 Abdomen and viscera (including hernia) X
27 Sinuses X 39 Anus (Not including digital examination) X
28. Mouth and throat X 40. Skin x
29. Ears, general (internal and external canals: hearing X 41 G-U system (Not including pelvic examination) X
under item 49)
42. Upper and lower extremities (Strength and range of X
30. Ear drums (Perforation) X
31 Eyes, general (Vision under item 50 to 54) X 43 Spine, other musculoskeletal X
32 Ophthalmoscope X 44 Identifying body marks, scar, tattoos (Size and X
33. Pupiis ( Equality and reaction) X
34 Ocular motility (Associated parallel movement, X 45. Lymphatics X
46. Neurologic (Tendon reflexes, equilibrium, senses, X
35. Lungs and chest (Not including breast examination)
47 Psychiatric (Appearance, behavior, mood, comm.,
36. Hear (Precordial activity, rhythm, sounds, and
46. General systemic

NOTES.Describe every abnormality in detail. Enter applicable item nbr before each comment.

04/24/2002 MID: 200000251458 Page #; 1

NCTA000010974
 Conversational Voice Test at 6 feet [XJPassrjFail Record Audiometric Speech Discrimination Score
Right Ear Left Ear
500 1000 2000 3000 4000 500 1000 2000 3000 4000

Distant Vision 51. a Near Vision 51.b. Intermediate Vision - 32 inches 52. Color Vision
Right 20/ 70 Corrected to 20/ 20 Right 20/ 30 Corrected to 20/ Right 20/ Corrected to 20/ fX) pass
Left20/ 70 Corrected to 20/ 20 Left 207 30 Corrected to 20/ Left 20/ Corrected to 20/ g Fail
Bolh 20/ 70 Con-ected to 20/ 20 Both 20/ 30 Corrected to 20/ Both 20V Corrected to 20/
53. Field of Vision 54. Heterophoria 20' (in prism diopters) Esophoria Exophoria Right Hyperphoria Left Hyperphoria
[XJNormalQAbnormal 0 0 0 0
55 Blood Pressure 56. Pulse 57. Urinalysis 58 ECG (Date)
Sitting, mm Systolic Diastolic (Resting) (If abnormal, give results) Albumin Sugar
130 88 72 rx]Normal QAbnormal
59. Other Tests Given
60. Comments on History and Findings: AME shall comment on all "YES" answers in the Medical History section and for abnormal findings of the examination.
(Attach all consultation reports, ECGs, X-rays, etc to this report before mailing ).

Limitation 1:
Must wear corrective lenses.

Significant Medical History QYes [X]No Abnormal Physical Findings ffYes [X]No
61. Applicant's Name 62. Has been Issued - fJMed. Cert. (XJMed. and Student Pilot Cert.
JARRAH.ZIAD gNo Certificate Issued - Deferred for Further Evaluation
QHas Been Denied - Letter of Denial Issued (Copy attached)
63. Disqualifying Defects (list by item number)
64 Medical Examiner's Declaration - I hereby certify that I have personally reviewed the medical history and personally examined the applicant named on this

Date of Examination Aviation Medical Examiner's Name Certificate/Form Nbr

07/11/2000 DROBA.ARTHUR R, FF1409528
Street: 1020 HONORE AVENUE AME Serial N umber 19175
City. SARASOTA State FL Zip 34232-0000 AME Telephone: 941-377-6674

34/24/2002 MID 200000251458 Page #.

NCTA000010975
JARRAH, ZIAD SSN: 888007106 Applld: 1999247521 Pl#:

[MROWLANO : 04/11/2002 9:00:25 AMJ

7-11-00 EXAM. NO ACTIONS/CORRESPONDENCE SHOULD BE GENERATED WITHOUT CLEARANCE FROM DR. SILBERMAN.

[KHATCHER : 10/04/2001 10:11.49 AM]

AMC-730 REQUESTING CERTIFIED COPY OF FILE, REQUEST IS COMPLETE, SENDING TO SCANNING.

3:35 PM Page#: 1

NCTA000010976
 DEPARTMENT OF TRANSPORTATION

CERTIFICATE OF TRUE COPY

I HEREBY CERTIFY that the attached is a true copy of the original
medical record of ZIAD JARRAH dated July 11,2000,

on file in the Aeromedical Certification Division

and that I am the legal custodian thereof.
Signed and dated at Oklahoma City, Oklahoma

this 4th day of October ,20 01

by JOYCE YOUELL
Acting Supervisor, Medical Records Section
Aeromedical Certification Division

Civil Aeromedical Institute

* * » * * • # * *********•*•******•»»•»**»•***«••»•»*»*** ****••**«*** ******** ******* ***********«•«»*

I HEREBY CERTIFY that JOYCE YOUELL

who signed the foregoing certificate is now, and was, at the time of signing
the legal custodian of the aforesaid records,

and that full faith and credit should be given his certificate as such..

IN WITNESS WHEREOF, I have hereunto subscribed

my name and caused the seal of the Department of

Transportation to be affixed this 4th

day of October ,20 01

at Oklahoma City, Oklahoma

HENRY K. BOREN, D.O.

(Signature)

Acting Manager, Aeromedical Certification Division

—
Civil Aeromedical Institute
Department a/Transportation

Form DOT F 2100.1 (9-69>

NCTA000010977
 FROM:

U.S. DEPARTMENT OF TRANSPORATION

__ FEDERAL AVIATION ADMINISTRATION
-= MUCH MONRONEY AERONAUTICAL CENTER
. CIVIL AVIATION SECURITY DIVUSION, AMC-700
P.O. BOX 25082
OKLAHOMA CITY, OK 73125

PRECEDENCE: SECURITY CLASSIFICATION:

Action. Class _

Info Uhdas

FOR INFORMATION CALL: Special Agem Brenda L Smith

7b2%
Phone Number (405) 954-IHV Fax: (405)954-4989

Page 1 of.

THIS MATERIAL IS FOR LAW ENFORCEMENT PURPOSES ONLY // is subject 10 the

of the Privacy Ac:. 5 U.S.C. J5Itz. and arry release or reproduction mn.it fie mads :n

NCTA000010978
 06:43 FAX 4059544989 AMC-730/SECURm

U.S. Dspjrtmont
Memorandum
of Trantporation
Fod«ral Aviation
Administration

Subii«c ACTION: Request for Certified Records October 4,2001

of Airman Documents

Manager, Compliance and Enforcement Brenda L. Smith, AMC-73 1

Branch, AMC-730 Atmof (405)954-7628
Fax: (405)954-4989
Manager, Medical Certification Branch,
AAM-330

Please forward to this office a certified copy of the complete file concerning the airman
listed below. A computer printout of the airman data is attached for reference.

NAME SSN Dale of Birth

Ziad JARRAH 888-00-7106 05/11/1975

If there is no airmen information available, please prepare a diligent search. Please

expedite this request. Chesc documents are needed as soon as possible. We appreciate
your assistance.

Mark W. Sweeney

NCTA000010979