1 APPENDIX 4. LIST OF SAMPLE FORMS AND LETTERS IN THIS AC Sample AC Form 8050-1, Aircraft Registration Application (see appendix 5).
Sample FAA Form 8130-6, Application for Airworthiness Certification (Amateur-Built) (see appendix 6).
Sample FAA Form 8000-38, Fabrication/Assembly Operation Checklist (see appendix 8).
Sample AC Form 8050-88, Affidavit of Ownership for Amateur-Built Aircraft (see appendix 9).
Sample AC Form 8050-2, Aircraft Bill of Sale (see appendix 10).
Sample letter for requesting an aircraft registration number under 14 CFR § 47.15 (see appendix 11).
Sample FAA Form 8130-12, Eligibility Statement, Amateur-Built Aircraft (see appendix 12).
Sample program letter to accompany application for airworthiness certificate (see appendix 13).
Sample FAA Form 8610-2, Airman Certificate and/or Rating Application (see appendix 14).
APPENDIX 5. SAMPLE AERONAUTICAL CENTER FORM 8050-1,
AIRCRAFT REGISTRATION APPLICATION
FORM APPROVED OMB No. 2120-0042
UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION-MIKE MONRONEY AERONAUTICAL CENTER AIRCRAFT REGISTRATION APPLICATION CERT. ISSUE DATE REGISTRATION NUMBER N 130EA UNITED STATES
AIRCRAFT MANUFACTURER & MODEL BUILDER - VANS RV-6 AIRCRAFT SERIAL No.
1001 FOR FAA USE ONLY TYPE OF REGISTRATION (Check one box) I] 1. Individual C 2. Partnership C 3. Corporation C 4. Co-owner D 5. Govt. C 8. Corporation NAME OF APPLICANT (Person(s) shown on evidence of ownership. If individual, give last name, first name, and middle initial.)
BUILDER, EARLY A.
TELEPHONE NUMBER: (903 ) 555-1212 ADDRESS (Permanent mailing address for first applicant listed.)
Number and street: __ 1240 Bois d' Arc Road Rural Route: P.O. Box:
CITY STATE ZIP CODE Savoy TX 75479
CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS ATTENTION! Read the following statement before signing this application.
This portion MUST be completed.
A false or dishonest answer to any question in this application may be grounds for punishment by fine and / or imprisonment (U.S. Code, Title 18, Sec. 1001).
CERTIFICATION I/WE CERTIFY:
(1) That the above aircraft is owned by the undersigned applicant, who is a citizen (including corporations) of the United States.
(For voting trust, give name of trustee: _ ), or:
CHECK ONE AS APPROPRIATE:
a. L A resident alien, with alien registration (Form 1-151 or Form 1-551) No.
b. • A non-citizen corporation organized and doing business under the laws of (state) and said aircraft is based and primarily used in the United States. Records or flight hours are available for inspection at _
(2) That the aircraft is not registered under the laws of any foreign country; and
(3) That legal evidence of ownership is attached or has been filed with the Federal Aviation Administration.
NOTE: If executed for co-ownership all applicants must sign. Use reverse side if necessary.
TYPE OR PRINT NAME BELOW SIGNATURE DATE Carlv A. Owner xx/ xx/ xx
SIGNATURE TITLE DATE
EACH PART SIGNATURE TITLE DATE BE NOTE Pending receipt of the Certificate of Aircraft Registration, the aircraft may be operated for a period not in excess of 90 days, during which time the PINK copy of this application must be carried in the aircraft.
AC Form 8050-1 (12/90) (0052-00-628-9007) Supersedes Previous Edition 1
1 APPENDIX 6. SAMPLE FAA FORM 8130-6, APPLICATION FOR AIRWORTHINESS
CERTIFICATE (AMATEUR-BUILT) (FACE SIDE) /i0/i0/i0/i0/i0/i0/i0/i0/i0 /i0/i0/i0/i0/i0/i0/i0/i0/i0 U.S. Department of Transportation Federal Aviation Administration
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
1. REGISTRATION MARK N130EA
2. AIRCRAFT BUILDER’S NAME (Make) Builder
3. AIRCRAFT MODEL DESIGNATION VAN’S RV-6
4. YR. MFR.
2001
FAA CODING
5. AIRCRAFT SERIAL NO.
1001
6. ENGINE BUILDER’S NAME (Make) LY-CON
7. ENGINE MODEL DESIGNATION 0-360 EXP
11. AIRCRAFT IS (Check if applicable) I. AIRCRAFT DESCRIPTION 8. NUMBER OF ENGINES ONE
9. PROPELLER BUILDER’S NAME (Make)
SENSENICH
10. PROPELLER MODEL DESIGNATION C2YK-1BF/F7661B4 IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) NORMAL UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON OTHER B X SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items) 7 PRIMARY 2 LIMITED 1 CLASS I 5 PROVISIONAL (Indicate class) 2 CLASS II 1 AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY 3 AERIAL ADVERTISING 4 FOREST (Wildlife conservation) 5 PATROLLING 6 WEATHER CONTROL 3 RESTRICTED (Indicate operation(s) to be conducted) 0 OTHER (Specify) 1 RESEARCH AND DEVELOPMENT 2 X AMATEUR BUILT 3 EXHIBITION 4 AIR RACING 5 CREW TRAINING 6 MARKET SURVEY 4 X EXPERIMENTAL (Indicate operation(s) to be conducted) 0 TO SHOW COMPLIANCE WITH THE CFR 7 OPERATING (Primary Category) KIT BUILT AIRCRAFT 1 FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE 2 EVACUATE FROM AREA OF IMPENDING DANGER 3 OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT 4 DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
8 SPECIAL FLIGHT PERMIT (Indicate operation to be conducted, then complete Section VI or VII as applicable on reverse side) 6 CUSTOMER DEMONSTRATION FLIGHTS II. CERTIFICATION REQUESTED C 6 MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE “Restricted Operation” and “Standard” or “Limited” as applicable.)
A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE NAME Early A. Builder
ADDRESS 1240 Bois d’Arc Road, Savoy, TX 75479 B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete items as indicated)
AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No. and Revision No.)
N/A X AIRWORTHINESS DIRECTIVES (Check if all applicable AD’s are complied with and give the number of the last AD SUPPLEMENT available in the biweekly series as of the date of application) 2001-13
AIRCRAFT LISTING (Give page number(s)) N/A
SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS X
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CFR section 91.417
TOTAL AIRFRAME HOURS
0.0 3 EXPERIMENTAL ONLY (Enter hours flown since last certificate issued or renewed)
0.0 D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seq . and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
III. OWNER’S CERTIFICATION
DATE OF APPLICATION 01/30/2002 NAME AND TITLE (Print or type) Early A. Builder, Owner
SIGNATURE Early A. Builder A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183(d) applies).
2 14 CFR part 121 CERTIFICATE HOLDER (Give Certificate No.) 3 CERTIFICATED MECHANIC (Give Certificate No.) 6 CERTIFICATED REPAIR STATION (Give Certificate No.)
5 AIRCRAFT MANUFACTURER (Give name or firm) IV. INSPECTION AGENCY
VERIFICATION DATE
TITLE
SIGNATURE
THE CERTIFICATE REQUESTED (Check ALL applicable block items A and B) A. I find that the aircraft described in Section I or VII meets requirements for 4 AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE FAA INSPECTOR FAA DESIGNEE B. Inspection for a special flight permit under Section VII was conducted by: CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 V. FAA
REPRESENTATIV
E CERTIFICATION DATE
DISTRICT OFFICE 4 DESIGNEE’S SIGNATURE AND NO.
1 FAA INSPECTOR’S SIGNATURE
2 APPENDIX 6. SAMPLE FAA FORM 8130-6, APPLICATION FOR AIRWORTHINESS
CERTIFICATE (AMATEUR-BUILT) (REVERSE SIDE) A. MANUFACTURER NAME
ADDRESS
B. PRODUCTION BASIS (Check applicable item) PRODUCTION CERTIFICATE (Give production certificate number)
TYPE CERTIFICATE ONLY
APPROVED PRODUCTION INSPECTION SYSTEM C. GIVE QUANTITY OF CERTIFICATES REQUIRED FOR OPERATING NEEDS VI. PRODUCTION
FLIGHT TESTING
DATE OF APPLICATION
NAME AND TITLE (Print or type)
SIGNATURE
A. DESCRIPTION OF AIRCRAFT
REGISTERED OWNER
ADDRESS
BUILDER (Make)
MODEL
SERIAL NUMBER
REGISTRATION MARK
B. DESCRIPTION OF FLIGHT CUSTOMER DEMONSTRATION FLIGHTS (Check if applicable) FROM
TO
VIA
DEPARTURE DATE
DURATION
C. CREW REQUIRED TO OPERATE THE AIRCRAFT AND ITS EQUIPMENT PILOT CO-PILOT FLIGHT ENGINEER OTHER (Specify) D. THE AIRCRAFT DOES NOT MEET THE APPLICABLE AIRWORTHINESS REQUIREMENTS AS FOLLOWS:
E. THE FOLLOWING RESTRICTIONS ARE CONSIDERED NECESSARY FOR SAFE OPERATION: (Use attachment if necessary)
F. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above; that the air craft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seq . and applicable Federal Aviation Regulations; and that the aircraft has been inspected and is airworthy for the flight described.
SIGNATURE VII. SPECIAL FLIGHT PERMIT PURPOSES OTHER THAN PRODUCTION FLIGHT TEST DATE
NAME AND TITLE (Print or type)
G. Statement of Conformity, FAA Form 8130-9 (Attach when required) A. Operating Limitations and Markings in Compliance with 14 CFR section 91.9, as Applicable B. Current Operating Limitations Attached H. Foreign Airworthiness Certification for Import Aircraft (Attach when required) C. Data, Drawings, Photographs, etc. (Attach when required) D. Current Weight and Balance Information Available in Aircraft
L. Previous Airworthiness Certificate Issued in Accordance with 14 CFR Section ____________ CAR ________________ (Original Attached) E. Major Repair and Alteration, FAA Form 337 (Attach when required) VIII. AIRWORTHINESS
DOCUMENTATION (FAA/DESIGNEE use only) F. This inspection Recorded in Aircraft Records
J. Current Airworthiness Certificate Issued in Accordance with 14 CFR Section (Copy attached)
1 APPENDIX 7. USEFUL ADDRESSES Federal Aviation Administration Aircraft Registration Branch, AFS-750 Mailing Address P.O. Box 25504 Oklahoma City, OK 73125-0504 Physical Address 6425 South Denning Oklahoma City, OK 73169 Telephone: (405) 954-3116 Fax: (405) 954-3548
Experimental Aircraft Association, Inc.
Mailing Address P.O. Box 3086 Oshkosh, WI 54903-3086 Physical Address 3000 Poberezny Road Oshkosh, WI 54902 Telephone: (920) 426-4821 Fax: (920) 426-6560 EAA aviation information services: (920) 426-4800 E-mail: infoserv@eaa.org Public Web site: www.eaa.org Members Only Web site: http://members.eaa.org/homebuilders/index.html
1 APPENDIX 8. SAMPLE FAA FORM 8000-38,
FABRICATION/ASSEMBLY OPERATION CHECKLIST
FABRICATION/ASSEMBLY OPERATION CHECKLIST Company Name .
Address .
.
Aircraft Model Document Name and Date .
Type of Aircraft .
Accomplished By Kit Manufacturer Amateur
FUSELAGE
1. Fabricate Special Tools or Fixtures
2. Fabricate Longitudinal Members, Cores or Shells
3. Fabricate Bulkheads or Cross Members
4. Assemble Fuselage Basic Structure
5. Fabricate Brackets and Fittings
6. Install Brackets and Fittings
7. Fabricate Cables, Wire, and Lines
8. Install Cables, Wires, and Lines
9. Fabricate Fuselage Covering or Skin
10. Install Fuselage Covering or Skin
11. Fabricate Windshield/Windows/Canopy
12. Install Windshield/Windows/Canopy
WINGS
1. Fabricate Special Tools or Fixtures
2. Fabricate Wing Spars
3. Fabricate Wing Ribs or Cores
4. Fabricate Wing Leading and Trailing Edge
5. Fabricate Drag/Anti-Drag Truss Members
6. Fabricate Wing Brackets and Fittings
7. Fabricate Wing Tips
8. Assemble Basic Wing Structures
9. Install Wing Leading/Trailing Edge and Tips
10. Install Drag/Anti-Drag Truss
11. Fabricate Cables, Wires and Lines
12. Install Cables, Wires, and Lines
13. Fabricate Wing Covering or Skin
14. Install Wing Covering or Skin
15. Fabricate Wing Struts/Wires
16. Install and Rig Wings and Struts
FAA Form 8000-38 (12-91)
2 APPENDIX 8. SAMPLE FAA FORM 8000-38,
FABRICATION/ASSEMBLY OPERATION CHECKLIST (CONTINUED)
FABRICATION/ASSEMBLY OPERATION CHECKLIST (Continued) Accomplished By Kit Manufacturer Amateur
FLIGHT CONTROLS
1. Fabricate Special Tools or Fixtures
2. Fabricate Aileron Spars
3. Fabricate Aileron Ribs or Cores
4. Assemble Aileron Structure
5. Fabricate Aileron Leading and Trailing Edge
6. Assemble Aileron Leading and Trailing Edge
7. Fabricate Aileron Brackets and Fittings
8. Install Aileron Brackets and Fittings
9. Fabricate Aileron Covering or Skin
10. Install Aileron Covering or Skin
11. Fabricate Aileron Trim Tab
12. Install Aileron Trim Tab
13. Install and Rig Aileron
14. Fabricate Flap Spars
15. Fabricate Flap Ribs or Cores
16. Assemble Flap Structure
17. Fabricate Flap Leading and Trailing Edge
18. Assemble Flap Leading and Trailing Edge
19. Fabricate Flap Brackets and Fittings
20. Install Flap Brackets and Fittings
21. Fabricate Flap Covering or Skin
22. Install Flap Covering or Skin
23. Install and Rig Flap
24. Fabricate Elevator Spars
25. Fabricate Elevator Ribs or Cores
26. Assemble Elevator Structure
27. Fabricate Elevator Leading and Trailing Edge
28. Assemble Elevator Leading and Trailing Edge
29. Fabricate Elevator Brackets and Fittings
30. Install Elevator Brackets and Fittings
31. Fabricate Elevator Covering or Skin
32. Install Elevator Covering or Skin
33. Fabricate Elevator Trim Tab
34. Install Elevator Trim Tab
35. Install and Rig Elevator
36. Fabricate Rudder Spar
37. Fabricate Rudder Ribs or Cores
38. Assemble Rudder Structure
39. Fabricate Rudder Leading and Trailing Edge
40. Assemble Rudder Leading and Trailing Edge
41. Fabricate Rudder Brackets and Fittings
42. Install Rudder Brackets and Fittings
43. Fabricate Rudder Covering or Skin
44. Install Rudder Covering or Skin
45. Fabricate Rudder Trim Tab
46. Install Rudder Trim Tab
47. Install and Rig Rudder
FAA Form 8000-38 (12-91)
3 APPENDIX 8. SAMPLE FAA FORM 8000-38,
FABRICATION/ASSEMBLY OPERATION CHECKLIST (CONTINUED)
FABRICATION/ASSEMBLY OPERATION CHECKLIST (Continued) Accomplished By Kit Manufacturer Amateur
EMPENNAGE
1. Fabricate Special Tools of Fixtures
2. Fabricate Spars
3. Fabricate Ribs or Cores
4. Fabricate Leading and Trailing Edges
5. Fabricate Tips
6. Fabricate Brackets and Fittings
7. Assemble Empennage Structures
8. Install Leading/Trailing Edges and Tips
9. Install Fittings
10. Fabricate Cables, Wires, and Lines
11. Install Cables, Wires and Lines
12. Fabricate Empennage Covering or Skin
13. Install Empennage Covering or Skin
CANARD
1. Fabricate Canard
2. Assemble Canard Structure
3. Install and Rig Canard
LANDING GEAR
1. Fabricate Special Tools or Fixtures
2. Fabricate Struts
3. Fabricate Brakes System
4. Fabricate Retraction System
5. Fabricate Cables, Wires and Lines
6. Assemble Wheels, Brakes, Tires, Landing Gear
7. Install Landing Gear System Components
PROPULSION
1. Fabricate Special Tools of Fixtures
2. Fabricate Engine Mount
3. Fabricate Engine Cooling System/Baffles
4. Fabricate Induction System
5. Fabricate Exhaust System
6. Fabricate Engine Controls
7. Fabricate Brackets and Fittings
8. Fabricate Cables, Wires and Lines
9. Assemble Engine
10. Install Engine and Items Listed Above
11. Fabricate Engine Cowling
12. Install Engine Cowling
13. Fabricate Propeller
14. Install Propeller
15. Fabricate Fuel Tank
FAA Form 8000-38 (12-91)