AC 21-12D Appendix A Figure A-2. Sample FAA Form 8130-6 (Back) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved OMB No. 2120-0018 Expires: October 31, 2026 A. MANUFACTURER
NAME ADDRESS VI. PRODUCTION FLIGHT TESTING B. PRODUCTION BASIS (Check applicable item) PRODUCTION CERTIFICATE (Give production certificate number)
TYPE CERTIFICATE thiness requirements but is capable of safe fight:
. GIVE QUANTITY OF CERTIFICATES REQUIRED FOR OPERATING NEEDS DATE OF APPLICATION NAME AND TITLE (Printor type) SIGNATURE A. DESCRIPTION OF AIRCRAFT
REGISTERED OWNER ADDRESS BUILDER (Make) MODEL
SERIAL NUMBER REGISTRATION MARK CUSTOMER DEMONSTRATION FLIGHTS (Check if applicable) TO
DEPARTURE DATE DURATION
CREW REQUIRED TO OPERATE THE AIRCRAFT AND ITS EQUIPMENT FLIGHT ENGINEER OTHER (Specify) D. THE AIRCRAFT DOES NOT MEET THE APPLICABLE AIRWORTHINESS REQUIREMENTS AS FOLLOWS:
se attachment if necessary)
VII SPECIAL F. CERTIFICATION - I hereby certify that l 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 applicab Federal Aviation Regulations; and that the aircraft has been inspected and is safe for the flight described DATE NAME AND TITLE (Printor type) SIGNATURE A. Operating Limitations and Markings in Compliance With 14 CFR Section 91.9. J. Superseded, terminated, or canceled airworthiness certificate Issued in Accordance With As Applicable 14 CFR Section — _ CAR — _ (Original attached) B. Current Operating Limitations Attached (FAA/DESIGNEE use only) K. Airworthiness Certificate Issued via this Application in Accordance With VIII. AIRWORTHINESS DOCUMENTATION C. Data, Drawings, Photographs, etc. (Attach when required) 14 CFR Section (Copy atfached) D. Current Weight and Balance Information Available in Aircraft L. Light-Sport Category Statement of Compliance, FAA Fom 8130-15 E. Major Repair and Alteration, FAA Form 337 (Attach when required) M. Reserved F. This inspection Recorded in Aircraft Records N. Denial Letter (Copy attached) G. Statement of Conformity, FAA Fom 8130-9 (Attach when required) O. Certification file forward to registry DOES NOT contain information that is proprietary.
confidential, companv-sensitive, subiect to International Traffic in Arms Redulations (TAR) H. Foreign Airworthiness Certification for Import Aircraft (Attach when required) (22 CFR, subchapter M), subject to Export Administration Regulations (EAR) (15 CFR part
734), or otherwise restricted from public or foreign disclosure . FAA For 8100-1, Conformity Inspection Record FAA Form 8130-6 (xx/xx) SUPERSEDES PREVIOUS EDITION Page 2 of 2 A-4
AC 21–12D Appendix B APPENDIX B. ACRONYMS B.1 Acronyms Used in This Manual.
• AC Advisory Circular
• AD Airworthiness Directive
• AD biweekly Airworthiness Directives Biweekly
• ASI Aviation Safety Inspector
• AWC Airworthiness Certification (Online Application Tool)
• CAA Civil Aviation Authority
• CAR Civil Air Regulation
• CFR Code of Federal Regulations
• DRS Dynamic Regulatory System
• FAA Federal Aviation Administration
• ID Identification
• N/A Not Applicable
• ODA Organization Designation Authorization
• PC Production Certificate
• STC Supplemental Type Certificate
• TC Type Certificate
• TCDS Type Certificate Data Sheet B.2 Reserved.
B-1
OMB Control Number: 2120-0746 Expiration Date:12/31/2027 Advisory Circular Feedback Form Paperwork Reduction Act Burden Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0746. Public reporting for this collection of information is estimated to be approximately 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, completing, and reviewing the collection of information.
All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524.
If you find an error in this AC, have recommendations for improving it, or have suggestions for new items/subjects to be added, you may let us know by (1) emailing this form to 9-avs-air-directivesmanagement-officer@faa.gov or (2) faxing it to the attention of the LOB/SO (202) 267-1813.
Subject: AC 21-12D, Application for U.S. Airworthiness Date: _______________ Certificate Mark all appropriate line items:
☐ An error (procedural or typographical) has been noted in paragraph _______ on page _______.
☐ Recommend paragraph _______ on page _______ be changed as follows:
☐ In a future change to this AC, please cover the following subject:
(Briefly describe what you want added.)
☐ Other comments:
☐ I would like to discuss the above. Please contact me using the information below.
Submitted by: __________________________________ Date: __________________ FAA Form 1320-73 (01/25) SUPERSEDES PREVIOUS EDITIONS