AUTHORITY:

PRINCIPAL PURPOSE:

10 USC 8012 and EO 9397

To aid in accurate identification of
personnel participating in the filed
flight.

BASE OPERATIONS USE

TYPE
TRUE
FLT
AIRSPEED
PLAN

DATE

PRIVACY ACT STATEMENT

ROUTINE USES: To provide data required to process flight plans with appropriate air traffic
service authorities. A file is retained by the agency processing the flight plan.
DISCLOSURE: Voluntary; however, failure to provide the SSN could result in denial of flight
plan processing.

POINT OF
DEPARURE

PROPOSED
DEPARTURE
TIME (Z)

ALTITUDE

AIRCRAFT CALL
SIGN

14 NOV 07

AIRCRAFT DESIG AND

TD CODE

H60 / U

ROUTE OF FLIGHT

TO

ETE

REMARKS

RANK AND HONOR CODE

FUEL ON BD

ALTN AIRFIELD

ETE TO ALTN

NOTAMS

WEATHER

WT AND BALANCE

AIRCRAFT SERIAL NUMBER, UNIT, AND HOME STATION

LOR /
SIGNATURE OF APPROVAL AUTHORITY
DUTY
PILOT
IN
COMMAND

CREW/ PASSENGER LIST

ATTACHED
SEE PSGR MANIFEST
NAME AND INITALS

ACTUAL DEP TIME

(Z)
RANK

/ USAAWC / LOR
BASE OPERATIONS USE
SSN

ORGANIZATION AND LOCATION

FERNANDEZ, J.

CW3

E Co. 1-212th / Ft RUCKER

PI

EVANS, J.

1LT

B Co. 1-145TH / Ft. RUCKER

PI

FONES, I.

2LT

B Co. 1-145TH / Ft. RUCKER

DD FORM 175, MAY 86

Previous editions are obsolete

MILITARY FLIGHT PLAN