# AC 21-12A: Application for U.S. Airworthiness Certificate, FAA Form 8130-6 (OMB 2120-0018)

- Type: Advisory circular (guidance, not mandatory unless a rule or AD requires it)
- Status: Historical
- Version in force: [AC 21-12D](https://openairdocs.org/ac/21-12), approved January 30, 2026. This is a historical version
- Approved: March 26, 1987
- Last reviewed: July 3, 2001
- Family: AC 21-12
- Cancelled by: [AC 21-12B](https://openairdocs.org/ac/21-12B)
- 14 CFR parts: 21
- Pages: 24
- PDF: https://openairdocs.org/files/sha256/13/66/136655b9aa6ebc05daa028f634cb829d735ec10991a32ce26543f1092fa38d23
- FAA DRS: https://drs.faa.gov/browse/excelExternalWindow/7230113771A1E41A862569AF007623C0.0001
- DRS record last changed: November 22, 2025
- Page: https://openairdocs.org/ac/21-12A

## Versions

- [AC 21-12D](https://openairdocs.org/ac/21-12) (Current), approved Jan 30, 2026, 40 pages
- [AC 21-12C](https://openairdocs.org/ac/21-12C) (Historical), approved Sep 7, 2012, 51 pages
- [AC 21-12B](https://openairdocs.org/ac/21-12B) (Historical), approved Nov 6, 2001, 30 pages
- [AC 21-12A](https://openairdocs.org/ac/21-12A) (Historical), approved Mar 26, 1987, 24 pages

## Text

Each page's text from the PDF; open the PDF at a page with #page=N. This is OCR from the scanned FAA advisory circular. OCR can misread letters and numbers.

### Page 1 (OCR)

Advisory U.S. Department of Transportation Circular Federal Aviation Administration Subject: APPLICATION FOR U.S. Date: 3/26/87 AC No: 21-12A AIRWORTHINESS CERTIFICATE, Initiated by: AWS-200 Change:

FAA FORM 8130-6 (OMB 2120-0018) PURPOSE. This advisory circular (AC) provides instructions on the preparation and submittal of Federal Aviation Administration (FAA) Form 8130-6 (issue 6-86 and subsequent) Application for Airworthiness Certificate. This application shall be completed not only to obtain an airworthiness certificate but also for any amendment or modification to a current airworthiness certificate.

2. CANCELLATION. AC 21-12, Application for U.S. Airworthiness Certificate, dated January 17, 1973, is cancelled.

* 3. INFORMATION. FAA Form 8130-6 bearing issue date (6-86) or subsequent should be used. This form is furnished by the FAA free of charge and is available at all FAA Flight Standards (FSDO) or Manufacturing Inspection District Offices (MIDO) (see Appendix 2).

4. INSTRUCTIONS FOR COMPLETING FAA FORM 8130-6, APPLICATION FOR AIRWORTHINESS CERTIFICATE. The applicant, or his agent, should complete Sections I through IV, or II and VI, or II and VII, as applicable for the type of airworthiness certificate being requested. The following instructions and explanations apply to the corresponding items on the form.

a. Section I. Aircraft Description.

NOTE: Do not complete this section when application is being made for a Special Flight Permit.

(1) Registration Mark. Enter the U.S. nationality designator (letter "N") followed by the registration marks as shown on the aircraft registration certificate. (Reference Federal Aviation Regulations (FAR) Part 45, Subpart C.)

(2) Aircraft Builder's Name (Make). Enter the name of the manufacturer or builder as it appears on the aircraft identification (ID) plate.

(Reference FAR Section 45.13(a) (1).)

(a) For amateur-built aircraft, the aircraft make is the name of the builder. when two or more persons are involved, enter only the name of the individual that is listed first on the aircraft's ID plate.

*puilder's name would be that of the person who assembled the aircraft and not the name of the manufacturer who builds the same model of aircraft under a production (b) For aircraft built from spare and surplus parts, the aircraft approval.

### Page 2 (OCR)

3/26/87 AC 21-12A

(c) For surplus military aircraft (not assembled from spare and surplus parts), the builder's name will be as listed on the type certificate data sheet (ICDS). *

(3) Aircraft Model Designation. Enter the model designation as shown on the aircraft ID plate. (Trade names should not be used.) (Reference FAR Section 45.13 (a) (2).)

(a) For military aircraft being processed for civil registry, enter the civil model unless the type certificate (TC) is issued under FAR Section 21.27.

In this case, the military model designation becomes the civil model designation.

(b) For aircraft built from spare and surplus parts, the model designation should be that civil model which is shown on the TCDS to which the applicant shows conformity.

(c) For military aircraft type certificated in the restricted category under the provisions of FAR Section 21.25(a) (2), only the military designation will be entered. *

(d) For amateur-built aircraft, the model may be any arbitrary designation as selected by the builder. If the aircraft was purchased as a kit, the model assigned by the kit supplier should be used.

* (4) Year of Manufacture. Enter the year of manufacture if shown on the aircraft ID plate or as reflected in the aircraft logbook.

(a) For aircraft eligible for standard airworthiness certificates, the year of manufacture is the date (entered by the manufacturer) the inspection records reflect that the aircraft is complete and meets the FAA-approved type design data.

(b) For aircraft, other than the above, the year of manufacture is the date of the statement in the records, entered by the assembler/builder, establishing that the aircraft is airworthy and eligible for the certificate requested. *

(5) Serial Number. Enter the serial number as shown on the aircraft ID plate per FAR Section 45.13(a) (3).

(a) For surplus military aircraft, enter the manufacturer's civil serial number. If no civil serial number exists, enter the military number.

For aircraft built from spare and surplus parts, enter the serial number assigned by the builder, providing it could not be confused with those assigned by an original manufacturer who builds the same type of aircraft under a production approval. It is suggested that a letter prefix or suffix, such as the builder's name or initials, be used with the number to provide a positive identification. *

(c) For amateur-built aircraft, the serial number may be any arbitrary number assigned by the builder.

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(6) Engine Builder's Name (Make). The engine make is the name of the manufacturer as it appears on the engine ID plate. (Reference FAR Section 45.13

(a) (1).) Abbreviations may be used, e.g., "P&W," "G.E.," "CMC," etc. When no engines are installed, as in the case of a glider or balloon, enter "N/A."

(7) Engine Model Designation. When engine(s) installed, enter the complete designation as shown on the engine ID plate; e.g., "R2800-99W," 'TVO-435-AIA," "I0-470-R," etc. (Reference FAR Section 45.13(a) (2)).

(8) Number of Engines. When applicable, enter the quantity of engines installed on the aircraft.

(9) Propeller Builder's Name (Make). Enter the name of the manufacturer as shown on the propeller identification data. Enter "N/A" if propellers are not installed. (Reference FAR Section 45.13(a)(1).)

(10) Propeller Model Designation. When applicable, enter the model designation as shown on the propeller identification data (Reference FAR Section 45.13(a) (2).)

(11) Aircraft is Import. This block should be checked only if the aircraft was manufactured in a foreign country and is being certified under the provisions of FAR Section 21.183(c). *

b. Section II. Certification Requested. All entries in this section are generally self-explanatory. The following paragraphs reference applicable regulations and other material (including examples) to assist in the completion of the application form for each certification that may be requested.

(1) Standard Airworthiness Certificate.

(a) FAR Part 21, Section 21.183.

(b) AC 20-65, U.S. Airworthiness Certificates and Authorizations for Operation of Domestic and Foreign Aircraft. *

(c) Appendix 1, pages 1, 2, 3, and 14 of this AC.

(2) Special Airworthiness Certificate.

(a) Limited Airworthiness Certificate.

1 FAR Part 21, Section 21.189.

2 AC 20-65, U.S. Airworthiness Certificates and Authorizations for Operation of Domestic and Foreign Aircraft.

3 Appendix 1, page 4 of this AC.

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(b) Provisional Airworthiness Certificate.

1 FAR Part 21, Section 21.221 for a Class I certificate and Section 21.223 for a Class II certificate.

2 Appendix 1, Page 5 of this AC. *

(c) Restricted Airworthiness Certificate.

1 FAR Part 21, Sections 21.25 and 21.185.

2 AC 20-65, U.S. Airworthiness Certificates and Authorizations for Operation of Domestic and Foreign Aircraft.

3 Appendix 1, page 6 of this AC.

(d) Experimental Certificate.

1 FAR Part 21, Sections 21.191, 21.193, and 21.195.

2 AC Nos. 20-27C, Certification and Operation of Amateur-Built Aircraft, and 20-65, U.S. Airworthiness Certificates and Authorizations for Operation of Domestic and Foreign Aircraft.

3 Appendix 1, pages 7, 8, and 9 of this AC.

(e) Special Flight Permit.

1 FAR Part 21, Sections 21.197 and 21.199.

2 AC Nos. 20-65, U.S. Airworthiness Certificates and Authorization for Operation of Domestic and Foreign Aircraft, and 21-4B, Special Flight Permits for Operation of Overweight Aircraft.

3 Appendix 1, pages 10, 11, and 12 of this AC.

(3) Multiple Airworthiness Certificate, i.e., Standard/Restricted or Restricted/Limited.

(a) FAR Part 21, Section 21.187.

(b) AC 20-65, U.S. Airworthiness Certificates and Authorization for Operation of Domestic and Foreign Aircraft.

(c) Appendix 1, page 13 of this AC.

c. Section III. Owner's Certification. Do not complete this section when application is being made for a Special Flight Permit.

4 Par 4

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(1) Registered Owner. Enter this information exactly as it is shown on the aircraft registration certificate. FAR Part 47 prescribes the requirements for registering aircraft under Section 501 of the Federal Aviation Act of 1958.

(2) If Dealer, Check Here. This block should be checked ONLY if the aircraft is registered under a dealer's aircraft registration certificate.

(Reference FAR Part 47, Subpart C.)

* Certificate Data Sheet and/or Aircraft Listing Block). This item should be restricted, or multiple airworthiness certificate. *

(a) When application is being made for a multiple airworthiness certificate, the certification basis for each certificate being requested should be entered.

(b) If the type certificate data sheet or specification for a new ircraft or model has been approved but not yet published, the date of approval, he IC or specitication number, and the word "preliminary" should be entered.

(c) This item is not applicable when application is being made for an experimental certificate. "N/A" should be entered.

* Airworthiness Directives. This block should be checked to indicate compliance with all applicable Airworthiness Directives (AD). List the number of the last AD supplement available in the biweekly series, as of the date of the application, regardless of whether or not that AD supplement applies to the aircraft. (Reference FAR Part 39 and FAR Section 21.99.)

* NOTE: Each AD contains an applicability statement specifying the product to which it applies. Some aircraft owners and operators mistakenly assume that AD's are not applicable to aircraft certificated in certain categories such as experimental or restricted. AD's, unless specifically limited apply to the make and model set forth in the applicability statement regardless of category. The type certificate and ertifica Reference airworthiness certification categories are used to identify the product affected. (Reference AC 39-7A, Airworthiness Directives for General Aviation Aircraft, paragraph 9).

(5) Supplemental Type Certificate. This block should be checked only when one or more Supplemental Type Certificates (STC) have been incorporated. The identification number of each STC installed should be shown. If more space is required, an attachment may be used. This block is applicable to all certification categories. (Reference FAR Part 21, Subpart E.)

(6) Aircraft Operation and Maintenance Records.

Par 4 5

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Records in Compliance with FAR Section 91.173. This block is applicable to all aircraft covered by this section and should be checked to indicate that the recordkeeping requirements of FAR Section 91.173 have been met.

FAR Section 91.173 requires information which would be applicable to all aircraft;

tor example, FAR Section 91.173(a)(2)(ii) requires a record of the current status of life-limited parts of each airtrame, engine, propeller, rotor, and appliance, while compliance with FAR Section 91.173(a)(2)(i) would require that production flight test time be entered in the aircraft's maintenance records.

(b) Total Airframe Hours. This block is applicable to all aircraft covered by this section. The total time in service of the aircraft, including production flight test time, should be entered.

(c) Experimental Only. When application is being made for the renewal of an experimental certificate, the hours flown since the previous pravine experimental certificate was issued or renewed should be entered. If the application is for an original issuance of an experimental certificate, zero hours should be entered.

(7) Certification. If signature is of the owner's agent, a notarized letter from the registered owner authorizing the agent to act on his behalf in this matter is required.

d. Section IV. Inspection Agency Verification. This section should be airworthiness certificate for an aircraft being certificated under FAR appropriately completed only if application is being made for a standard 183(c0). Thie section shou Section 21.183(d). This section should be left blank for all other certification actions.

e. Section V. FAA Representative Certification. This section will be'' ....

completed by the FAA representative that inspects the aircraft and issues the certificate.

f. Section VI. Production Flight Testing. This section should be completed ONLY BY A MANUFACTURER applying for a special flight permit for the purpose of flight testing production aircraft. (Reference FAR Section 21.197(a)(3).)

Section VII. Special Flight Permit Purposes Other Than Production Flight Test.

(1) Item A. Description of Aircraft. The entries in this section should be the same as the corresponding data recorded on the aircraft's registration certificate and, as applicable, on the aircraft's identification plate.

(2) Item B. Description of Flight. Self-explanatory except that:

(a) The "via" block should contain the name of an airport or city at some intermediate point in the flight to provide a general description of the route flown. For example, a flight from Kansas City, Missouri, to Dallas, Texas, may be via Wichita, Kansas, and Oklahoma City, Oklahoma. (Reference FAR Section 21.199(a) (2).)

6 Par 4

### Page 7 (OCR)

(b) The "duration" entry should reflect the overall duration of the special flight permit and need not be the same as the planned duration of the actual flight. Factors such as fueling stops, weather conditions, overnight ettablishing the duration. (Reference FAR Section 21.199(a) (2).) or any other reasonable condition should be given consideration when so not say ith the spite to sirectine regions in

(4) Item E. The Following Restrictions are Considered Necessary for Safe Operation. This entry should contain in detail the restrictions the applicant considers necessary for safe operation of the aircraft; for example, reduced airspeed or weight, turbulence avoidance, crew limitations or qualifications, and the like. (Reference FAR Section 21.199(a)(5).)

h. Section VIII. Airworthiness Documentation. This section will be completed by the FAA representative who inspects the aircraft and issues the airworthiness certificate.

INSTRUCTIONS FOR SUBMITTING THE COMPLETED FAA FORM 8130-6, APPLICATION FOR AIRWORTHINESS CERTIFICATE. When the applicant has completed the applicable sections and signed the FAA Form 8130-6, it should be submitted, together with any other material that may be required by the regulations for the airworthiness certification being requested, to the appropriate FAA Flight Standards District Office, Manufacturing Inspection District Office, Designated Manufacturing Inspection Representative (DMIR) or Designated Airworthiness Representative (DAR) as appropriate. When the address of the district office that will process the application is not known, it may be obtained from the FAA regional office serving the area wherein the applicant is located. Appendix 2 of this circular contains the addresses of the FAA regional offices and the geographical area governed by each.

**6. HOW TO ORDER THE REFERENCED PUBLICATIONS.**

a. Federal Aviation Regulations. Order from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.

b. Advisory Circulars. Requests for the following FREE Advisory Circulars should be submitted to: Department of Transportation, Distribution Unit, M-494.3, Washington, D.C. 20590.

(1) AC No. 20-27C, Certification and Operation of Amateur-Built Aircraft.

Par 4 7

### Page 8 (OCR)

3/26/87 AC 21-12A

(2) AC No. 20-65, U.S. Airworthiness Certificates and Authorizations for Operation of Domestic and Foreign Aircraft.

(3) AC No. 21-4B, Special Flight Permits for Operation of Overweight Aircraft.

7. REQUEST FOR INFORMATION. For additional information, interested parties should contact those offices listed in Appendix 2 of this AC.

Willin fallin Deputy Director of Airworthiness Office of Airworthiness 8 Par 6

### Page 9 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A STANDARD

AIRWORTHINESS CERTIFICATE - NO PREVIOUS U.S. AIRWORTHINESS CERTIFICATE ISSUED Form Approve O.M.B. No. 2120-0011 APPLICATION FOR AIRWORTHINESS spece le required, use an ettachment. For speck se onty. Submi originel only to an CERTIFICATE Il and VI or VIl as applicabl LAEGISTRATION MARK ZAACRAFT BUALDE N8 MASSE (0R0NO) 2 AIRCRAFT MODEL DESIONATION a MA. AFA PAA CODEN N12345 Boeing 737-247 11985 & AIRCRAFT SERLAL NO 6. ENGINE BUILDER'S NAME (MahO) 7. ENGINE MODEL DESIGNATION 19714 PEW JT8D-9

2. NUMBER OF EN N/A DER'S NAME (M00NO) 92. PROPELLER MODEL DES N/A JATION 11. ARCRAFT IS I Check Y applicaon FORT * CAPONY NORMAL UTILITY ACROBATIC X TRANSPORT GLIDER BALLOON

SPECIAL AAMORTHAESS CERTIFICATE (CROCK COPCOND BONO) LATED CLASSI CLASS :

AGRICULTURE AND PEST CONTRO AFALAL SUAVEYINO 3 AERIAL ADVERTISINN NOTATED (INCON CHEMONY 0) NO PATROLLINI WEATHER CONTROI D / CARPADE OF CARDO OTHER (Specify NESEARCH AND DEVELOMMENT AMATEURDUNT D • EXHIBITION CREW TRAMING MKT. SURVEY PECIAL FLIGHT PERMIT (InhOS •E FROM AREA OF MPENDING DANGER on to do conducted. the

STRATION PLENTE cD MULTIPLE AWORTHNESS CERTIFICATE /CHECH ABOVE TOSH A MEGISTERED OWNER (As chown en cortices of arcel regenesion) * DEALER, CHECK MENE - The Boeing Company Washington 98124 COME CHECNICATION OR TIPE CEFNTRICATE DATA BRET EM NA A16KE Rev. 10

**ACREST LETING (CHA PARO ANDONO)) -NA C. AIRCRAFT OPERATION ANO MAINTENANCE RECORDS**

**TOTAL AMARAME MOUNS**

17.8 • N/A 3/29/XX John R. Doe Taken R doe.

• THE AIRCRAFT DESCRIBED ABOVE MAS BEEN INSPECTED AND FOUND A my "FAR 2!

reme

**NOMATURE**

CROCK ALL THE CENTIFICATE REQUESTED .І.Т. NENOMENT OR MODIFICATION OF OUN TUFICATE сого вок а проскі суть дом FAANOPECTOR FAA DESIONEI CERTIFICATE HOLDER UNDER FAROS FAR 121, 127 - 108 FAR 146

**NOT OFFICE WO NO FAA INSPECTORS SIGNATUN 1**

### Page 10 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A STANDARD

AIRWORTHINESS CERTIFICATE - IMPORT GLIDER Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do nol write in shaded arees: these are for FAA use only. Submit original only to an authorized FAA Representative. H additional AIRWORTHINESS space is required, use an attachment. For special fight permits como ana Sectione CERTIFICATE Il and VI or VIl as applicable.

LNEGISTRATION MANK LAIRCRAFT BUILDER'S MAME (PANO) 2 ARCRAFT MODEL DESIONATION TA YA LEA FAN CODINO N53B Schleicher AS-K13 1984

2. AIRCRAFT BENAL NO. 6. ENGINE DULDER'S NAME (MaNO) 7. ENGINE MODEL DESIGNATION 101 N/A N/A & NUMBER OF EI NES a PROPELLER BUALDER'S NAME (MONO) 10. PROPELLER MODEL DESIONATION 11. ALACRAFT 1S (Choch /applicable)

NA INZA IX LOAT этар AS CERTIFICATE (melceto coregorY) VORAL UTILITY ACROBATIC TRANSPORT X GLIDER BALLOON LENTED

CLASS I CLASS 1 AGRICULTURE AND PEST CONTROL 8 AERIAL SURVEYING 3 AERIAL ADVERTISI RESTRICTED (ANDON OpENEDON(8) 0 PATROLLINO WEATHER CONTROL DE OF CARDO OTHER (SECtY

EARCH AND DEVELOPMENT D AMATEUMBULLT EXMBITION CREW TRAMING MKT. SUAVEY -TO SHOW COMFLLANCE WITH FAR

FERNY FLIGNT FOR REPAIRS, ALTERATIONE, MANTENANCE OR STORAGE MECIAL FLIGHT PENNAT (CON • AREA OF IMPENDINO DANGER san to do conducted. in IN EXCESS OF MAXMIM CERTIFICATED TAKE-OFF WEIGHT

•... ON EXPORT PRODUCTION FLIGHT TESTING

NSTRATION FLINTS GO MULTIPLE AM ESS CERTIFICATE /CROCH ABOVE 7 518 n5 or runs a con A REGISTERED OWNER (As shown en caricate of encret repeation • DEALER, CHECK HENS - Elmer E. Jones NAME 0 3. 60, 51 ego, California 95472 ARCRAFT CENTIFICATION BASIS / CoNCH apolcaNo bOcke and CONTAM/CATION OR TYPE CENTRICATE DATA NEET (EM NECTIVES / CHOCH HOMOA puceto AD = a G15EU 86-06-04

**MENTAL TYPE CENTEFICATE ILE N/A**

**ENTAL OALY (ENN NOU**

DATE OF AFPLICATION NAME AND TITLE FAI CHEA 6/13/XX Elmer E. Jones, • Owner CANT 11 CA 127 CE ECTED AND FOUND A ENTIFICATED M ITHY ST: IC ИС 1040 FAR 81.19(6) TRICATED NETAN TATION

**DONATUNE**

**THE CENTIFICATE NEOLESTED ENT ON MODIFICATION OF CURRENT ANK 3S CERTIFICATE**

FRAI FAA DESIONEE CENTIFICATE HOLDER UNDER | FAN 221. оu 286 1 кат над

**FE AND NO FAA ISPECTORS 2**

### Page 11 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A STANDARD

AIRWORTHINESS CERTIFICATE - AIRCRAFT BUILT FROM SPARE AND SURPLUS PARTS - NO PREVIOUS U.S.

AIRWORTHINESS CERTIFICATE ISSUED Form Approved O.M.B. No. 2120-0018 APPLICATION FOR •STRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA AIRWORTHINESS spece is required, use anattachment. For special flight permits complete Sections uss onty. Submit original only to an authorized FAA Representative. If additional CERTIFICATE Il and VI or VIl as applicable.

IREGISTRATION MANK ZARCRAFT BUILDENTS NAME (MONO) 2, AIRCRAFT MODEL DESIGNATION - YR AFR FARCOCANE.

N6934M Smith C-172M 1980 & AHCRAFT BERLAL NO 6. ENGINE BUILDER'& NAME (404O) 7. ENGINE MODEL DESIONATION Smith 001 Lycoming 0-320-B & AUMBER OF ENGINES & PROPELLEA BUILDER'S NAME (MOKO) 38. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check / appiceD) one McCauley 10160/CM

APPLICATION IS MER A 1 X STANDARO AM ACOS COMpOr) 5 NORMAL UTALITY ACROBATIC TRANSPORT GLIDER BALLOON SPECIAL AIMORTHINESS CENTIFICATE (CACH • CLASS MAL (Indicate 04000) NO PEST CONTROL 3 AERLAL SURVEYING 8 AERIAL ADVERTIS

**PATROLLING WEATHER CONTRO**

LE OF CARGO OTHER (SPECAY MANO DEVELOPMEN! AMATEURBUALT EXMIBITION CREW TRAININK UKT. SURVEY

**SE WITH FAR**

**EPAIRS, ALTERATIONE, MAINTE OR STORAGE**

**AL FLIOHT A ROM AREA OF IMPENDINO DANDER N EXCESS OF MAXMUM CERTHICATED TAKE-OFF WEIGHT**

**OR EXPORT ON FLIGHT TESTING**

ISTRATION FLIGHTE "ABOVE " and of Linted. as app A REGISTERED OWNER (AS (alian) • DEALER, CHECK HEN 6224 Arbor Way Johh R. Smith field. Tenn. 70653

0. AVACRAFT CENTIFICATION BASIS /CAOCH MCAMCORPECIFICATION OR TYPE CENTIFICATE DAT nock i one men and give H-1 Rey, 36 86-06-04 INCRAFT LISTING (Ono pago n NTAL TYPE CENTIFICATE (LI ANDOr aI O00S STC NOON

N/A N/A UNCE RECORD!

**TOTAL AIN E HOURI**

6.5 N/A DATE OF APPLICATION NAME AND TITLE PONI John A Smith 4/23/XX John R. Smith, Owner

A THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AN FAR PART 121 OR 127 CERTIFICA 11000 CERTIFICATED MECH _4326 4/18/XX Chief Inspectar Kani Cocora ¡CAOCH ALL ON THE CER

AMEN NODIFICATION OF CURRENT AMWONT FICATE 281 2 0 FAA DEF • FAA DESIONEE CERTIFICATE HOLDER UNDER FAROS FAR 121, 127 or 186 FAR 10g

**DATE T OFFICE E AND NO FAA D SONATURE 3**

### Page 12 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

AIRWORTHINESS CERTIFICATE - LIMITED -orm Approve D.M.B. No. 2120-001 APPLICATION FOR NSTRUCTIONS - Print or type. Do not write in ded areas: these are for FAA use onty. Submil original only to an authorized FAA Representative. Hadditional US D AIRWORTHINESS space ia required, use an attachment. For special flight permits complete Sections CERTIFICATE Il and VI or Vil as applicable.

REGISTRATION MANK 2AIACRAFT BUILDER'S NAME (000NO) 2. AIFCRAFT MODEL DESIGNATION 6. YA MFR FAA CODINA N1256 Martin B-26C 1943

6. ANACRAFT BEMAL NO & ENGINE BULDER'S NAME (ANO) 7. ENGINE MODEL DESIONATION 2256 PEW R-2800-83AM8 & NUMBER OF ENCHNES 8. PROPELLER BUILDER'S NAME (MONO) 18. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS /Check if eppliceble Tua Hamilton Standard 42E60-7/6895-8 | INFORT

APPLICATION IS HEREBY E : (Indices cologor!) NORMAL UTILITY ACROBATIC TRANSPORT GLIDEA BALLOON (PECIAL AIRMORTHINESS CERTIFICATE (Check expropne doms) LIATED CLASSI MOVISIONAL (Indicato chess) CLASS M AGRICULTURE ANO PEST CONTROL • AERIAL SURVEYANO 8 AERLAL ADVERTISINT

PATROLLING WEATHER CONTRO MADE OF CARDO OTHER (Specty)

**ACH AND DEVELOPMENT AUATEUABUKT EXHIBITION CREW TRAMING MKT. SURVEY**

**ICE WITH FAN I FOR PEPARS. ALTERATIONS. MANTENANCE OF STORAGE**

AREA OF IMPENONG DANDER sackon Vl or Vu as INE ESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIOH

•PRODUCTION FLIGHT TESTING

STRATION FLIONTS ABOVE T Jord or A. REGISTERED OWNER (As on • DEALER, CHECK MERE NAME est 48th Street Gas Transmission Company Dal „Texas 64072

•. AIRCRAFT CERTIFICATION BASIS (CROCH eSpIcab DOC ACRAFT SPECIFICATION OR TYPE CERTIFICATE DATA HORN FEE DIRECTIVES 1C * ADs e had with and goo as Ransion Na.) AL-33 _Rev.1 86-01-02 ACRAFT LISTING (GAO PAgO LEMENTAL TYPE CERTIFICATE. 'LON mader el each STC inc

NA N/A

RAFT OPERATION ANO MANTENANCE RECORDE HECK IF NECONDS • TOTAL AN FRAME HOURS An oh.173 12,632 N/A arry and cupies for the JATE OF APPLICATION LAME AND TITLE (AN OF 800) RogerouN 1/12/XX George Brown, President

**TRICATED NE NATURE**

**THE CERTIFICATE REQUESTED**

**MENOMENT OF MODIFICATION OF CUMENT ANWORTHIN ESS CENTIFICATE**

FAADESPECTON FAA DESIONEE CENTIFICATE HOLDER LINDER: FAres FAM 121. 127 or 196 FAR 166

**ME AND NO FAA INEPECTORS SIGNATURE**

### Page 13 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

AIRWORTHINESS CERTIFICATE - PROVISIONAL Form Approved O.M.B. No. 2120-0012 APPLICATION FOR INSTRUCTNS - Prit or type. Do not = aded areas; these are for FAA US DEE AIRWORTHINESS spece is required, use an attachment. For special flight permits complete Sections use only. Submit original only to an authorized FAA Representative. Madditions CERTIFICATE Il and VI or VIl as applicabu

1. REGISTRATION MARK ZAIRCRAFT BUILDER'S NAME (MONO, 2 AIRCRAFT MODEL DESIGNATION 1a. YA AFA FAA CODINO.

N502A Lockheed-Georgia Co. 382 1960 &. AIRCRAFT SERIAL NO •. ENGINE BUILDER'S NAME (Make) 7. ENGINE MODEL DESIGNATION 4100 Allison 501-D22A & NUMBER OF ENCINES A PROPELLER BUILDER'S NAME (MaNO) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT 18/Choc JOUr Hamilton Standard 54H60-91/54H60-117 IMPORT APPLICATION IS HEREBY MADE FOR: (Chach apocablo Name) • STANDARD ANWORTHINESE CEATIFICATE (indicale calegory) NORMAL UTULITY ACROBATIC | TRANSPORT OLIDER ALLOON

**SPECIAL AINWORTHINESS CERTIFICATE (CHECK SOON**

**LIAITED CLASSI**

• CENTIFCATION REQURE • × MROVISIONAL (Indices eteRs) CLASS H AORICULTURE ANO PEST CONTROL | 2 AERLAL SLAVEYINO AERIAL ADVERTISINC RESTRICTED (Indicato coordioN 8) 10 FOREST (WAto consometion) PATROLLING WEATHER CONTRO do conductse) WAGE OF CARGO (OTHER (Specity) RESEARCH AND DEVELOPMENT AMATEUMBULT 9 EXMIBITION EXPERIMENTAL (INCOND OMORENOM(O) RACING CREW TRAMNG MKT. SURVEY 10 bo conductad)

SHOW COMPLLANCE WITH FAR SPECIAL FLIGHT PERENT (IndicoN E FROM AREA OF IMPENDING DANGER amplato Saction VI or VIl as ON IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEID do on revares sido) MULTIPLE AI IS CERTIFICATE (ChocK ABOVE " A REGISTERED OWNER (As snown on corn case ol aucrati regretration; * DEALER, CHECK HEN -

NAME ADDRESS Lockheed Georgia Co, orgia 30060

8. ACRAFT CERTIFICATION BASIS (Check eppicable blocks end complete doms =e CRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (GO TRUCTIVES ( CROCH HON • AD> COMA un and give AISO 86-01-01 SUPPLEMENTAL TYPE CERTIFICATE (LIM O don cheech STC N/A C. AIRCRAFT OPERATION AND MANTENANCE RECOROS MALUNCE WITH ™N TOTAL AIRFRAME HOURS 10.2 NTAL ONLY (Emar houra N/A D. CERTIFICATION - 11 Unworry and eligible for the i DATE OF AFPLICATION NAMEANOTITLE (MiMeO) James A. JOneS TA Jones 2/16/XX Vice-President Engineering A THE AIRCRAFT DES FAR PART 121 OR 127 CERTI STED AND FOUND AIRWORTHY BY: ICE my a FAR 21.160(G) appos TRICATED REPAR ETATION GAD CAN

**BIONATURE (CROCH ALL THE CERTIFICATE REQUESTED**

**AMENDMENT OF MODIFICATION OF CURRENT A CERTIFICATE**

FAAINEMECTOR FAA DESIONEE CERTIFICATE HOLDER UNDER FAROS FAR 122, 127 o,138 FAR 30G OMATURE ANO NO. FAA INSPECTORS SIONATURE 5

### Page 14 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

AIRWORTHINESS CERTIFICATE - RESTRICTED Form Approved O.M.B. No. 2120-0018 APPLICATION FOR NUTRUCTIOWS - Print or type Do not write in shaded areas: these are for FAA was onty. Submit original only to an authorized FAA Representative. Hadditional AIRWORTHINESS space is required, use an attachment. For special flight permits complete Sections CERTIFICATE Il and VI or Vil as applicable INEGISTRATION MANK ZAIRCRAFT BULDER'S NAME (MONO) 2. AIRCRAFT MODEL DESIGNATION a YA AFR FAA COONO N7777 No. American Rockwell S2R 1950 &. AIRCRAFT SERLAL NO 6. ENGINE DULDER'S NAME (Make) 9. ENGINE MODEL DESIGNATION 1916R P&W R1340AN1 (S3H1) & NUMBER OF ENGINES a PROPELLEN BUILDER'S NAME (Mako) 10. PROPELLEA MODEL DESIGNATION 11. AIRCRAFT IS (Check il applicable) One Hamilton Standard 12D40-305/EAC/AG 100-2 • IPONT

APPLICATION IS MEREDI I STANDARD AM ATE (Indicato coregory) NORMAL UTRITY ACROBATIC TRANSPORT GLIDEA BALLOON I SPECIAL AIRWORTHIN FICATE (Check appropneto moma)

- LORAITED 9 CLASS!

AERIAL SURVEYING AERLAL ADVERTIS RESTRICTED (ACCO OY0) PATROLLINO WEATHER CONTROL do conducted) OTHER (SpecAY)

WENT AMATEUR BUILT EXMIBITION so conduca ACING CREW TRAMNG MKT SURVEY INT FOR REPAIRS. ALTERATIONS. MAINTENANCE OR STORAGE

**ECIAL FLIGHT PEDANT (INO**

OY IN EXCESS OF MA MUM CERTIFICATED TAKE-OFF WEIGHT Secton VI or Vil ei on rovered auto. IGHT TESTING

ISTRATION FLIGHTS G D MULTIPLE AIRWORTHINESS CERTIFICATE /ChECK ABOVE 20." 08 200.

A REGISTERED OWNER (As shown on certicate of excreft regretration • DEALER, CHECK HERE NAME John J. Jones, R.B. Jones 1. 5 DBA Crop Dusters, Inc. Mississippi 39070

8. AFCRAFT CEFTIFICATION BASIS (Chech applicable blocke and co EMER'S CERTIFICATION MANOR /FICATION OR TYPE CENTFICATE DATA SNE we AD No.)

A4SW Rev. 5 86-03-02 JACRAFT LISTING (Gno Dago numboMO)) ENTAL TYPE CENTIFICATE (LuI mAmbo el acch STC.

_NZA N/A C. AIRCRAFT OPERATION AND MANTENANCE RECOROS

TOTAL AIRFI NE MOL ~ FAN D1.17 210 N/A inverony and algiddo for the am 17 /XX AVE AND TITLE (PUM Or 8790) John J. Jones, Co-Owner Kohn So- AND FOUND AMWORTHY BY: IC # FAR 21.183(€) appro RTIFICATED ME nicero du NIC 10m0

**ONATURE**

**TIFICATE REQUESTED**

**ODIFICATION OF CUM SS CERTIFICATE**

FAA DESIGNEE CENTIFICATE HOLDER UNDER. AR06 (Fan 121, 127 or 196 Far ros : AND NO FAA N 6

### Page 15 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

**AIRWORTHINESS CERTIFICATE - EXPERIMENTAL**

AMATEUR - BUILT Form Approved O.M.B. No. 2120-0016 APPLICATION FOR AIRWORTHINESS epece is required, use an attachment. For special flight permits complete Sectione NSTRUCTIONS - Print or type. Do not write in s se onty. Submit original only to an authorized FAA Representative. Madditione ted areas: these are for FAA CERTIFICATE and VI or Vil as appliceble.

INEGISTRATION MANK 2AIRCRAFT BLALIXER'S NASDE (00000) 2. AIRCRAFT MODEL DESIONATION a YA AFA FAR CODEMO .

N1234 Pratt B-3 1986 &. AIRCRAFT SERIAL NO. 6. ENGINE BUILDER'S NAM 7. ENGINE MODEL DESIGNATION 001 CMC A-65

2. NUMBER OF ENGINES •. PROPELLEA DI 12. PROPELLER MODEL DESIONATION 11. AIRCRAFT 1S / ChOC 1540) One Sensenich N76AM-2-50

UPPLICATION IS MEI NORMAL • TRANSPORT GLIDER BALLOON

**X SPECIAL ARMORTHNESS CERTIFICATE /CA**

**LIMITED**

**CLASS I**

• • PROVIEIONAL (InACENe chess) CLASS H

**AERIAL SURVEYINO**

RESTRICTED (ON PATROLLINO WEATHEN CONTRO do conducted) OTHER (Specity 1 CERTIFIC AMATEUM BUILT EXMEITION EXPE! MENTAL (ON UKT. SURVEY co do conducess.

**E WITH FAR**

**URS, ALTERATIONS, MAI OR STORAGE**

**A OF BAPE**

**FICATED TI**

**D RODUCTION FLIGHT TESTIN**

MATION FLIONTE c O MULTIFLE AIRWORT ch ABOVE 700 Leaves: 06 00 A REGISTERED OWNER (As shown on a * DEALER, CHECK HEN MAME HOward D. Pratt 20 West St.

1000 A Smith Co ris. Missouri 41346 B. AIRCRAFT CERTIFICATION BASIS /CAC cocks and co ANANT ARE NICATION OR TYPE CEA VES I CHOCH A C nand gio _N/A 86-19-01 CRAFT LISTING IGNO PADO. NTAL TYPE CERTIFICATE Let mumber of soch STC

N/A N/A

ATION AND MAINTENANCE RECORDI TOTALAIA INTAL ONLY (Emor hours

0.0 0.0 DATE OF APFLICATION 2/16/XX Howard D. Pratt, Co-owner NAME AND TITLE (PAM ON O0) ward, of. Matt A THE AIRCRAFT I CEO MOPONL THY BY: IC FAN PART 121 OR 187 CE CENTIFICATED MECHANG (ON

**DONATURE**

THE CENTIFICATE REQUESTED ..r. AMENDMENT OR MODIFICATION OF CURNENT AIRWORT FICATE

**FAA DESIONEE ATE HOLDER UNDER FARCE FAR 181. 127 0 100 FAR 206**

**IST OFFICE NE AND NO FAA INSPECTORS SIONATURE**

### Page 16 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

**AIRWORTHINESS CERTIFICATE - EXPERIMENTAL**

**NO PREVIOUS EXPERIMENTAL**

CERTIFICATE OF AIRWORTHINESS ISSUED Form Approved O.M.B. No. 2120-0018 APPLICATION FOR #STRUCTIONS - Prim or type Do not write in shaded ares these are for FAA uS Dep AIRWORTHINESS use only. Submit original only to an authorized FAA Repre space ia required. use an attachment. For special flight permits complete Sections ntativa. If additional CERTIFICATE H and Vl or Vil as applicable.

IREGISTRATION MARK ZAMORAFT BULDENSA 2. AVACRAFT MODEL DESIONATION a YA AFA PAR CODINE N5216 Boe inc 727-228 1968

8. AIRCRAFT SERLAL NO 1. ENGINE BUILDER'S NAME (MaKe 7. ENGINE MODEL DESIGNATION DESCI 20540 P&W J180-7 &. NUMBER OF ENGINES 2. PROPELLEN BUILDE 18. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Chock ,l applicabo)

NVA N/A AFPLICATION iS HEREBY MADE FOR (Check appUCaDe Nems) - | STANDARD AMMORTMINESS CERTIF INORMAL UTILITY ACROBATIC | | TRANSPORT OLIDER _ BALLOON

• x | SPECIAL ATMORTHINESS CERTIFICATE / CAECH ESPIO LANTED

CLASS I MROVISIONAL (Inchoate Oless) CLASS F

**AGAICUL TURE AND PEST CONTROL AERLAL SUAVEYING AERIAL ADVERTISING**

**PATHOLLINO WEATHER CONTROL**

• CENTIACATION do conducted) CARRAGE OF CARDO OTHER (Specify) DEVELOPMENT AMATEUR BUILT ¡ EXMIBITION EXPERMMENTAL (MACON OperatONE) to do conducted) CREW TRAING MKT. SUAVEY LANCEWTHFAr Part 25 Y FLIGHT FOR REPAIRS. ALTERATIONS. MAWNTENANCE OR STORAGE

SPECUAL FLIGHT PERMIT (ASCEN A ON EXCES OF MANIAN CENTRICATED TAKE OPT WENT EVA AREA OF IMPENDING DANGER coad. man JA EXPORT • MODUCTION FLIGHT TESTING I cuSTE TRATION FLIONTS MULTIPLE AIRY S CERTIFICATE /Check ABOVE A REGISTERED OWNER (As shown on conticate of eucreft re NAME ADORESS J. Box 3707 • DEALER, CHECK HERE - The Boeing Company att. Washington 98124

0. AIRCRAFT CERTIFICATION BASIS (CRECH eppACE MOCks and cOm CRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Q0O N CTIVES / Choch doNe ned Reveren No.) NZA 86-02-02 AVACRAFT LISTING (ano Dago nABONO)) ENTAL TYPE CERTIFICATE (LaI mambo di acch STC

N/A N/A C. AICRAFT OPERATION AND MAINTENANCE RECORDE 19 91.173 TOTAL AINFRANE HOURS 5,51 ARE MENTAL ONLY EME NOT 0,0 Mom R.B. Smith KE Suith hiness Cert. Mar.

• ~2 TRICATED REPAR STATION

**BINATURE (CAOCH ALL THE CERTIFICATE REQUESTED**

**DDIFICATION OF CL ES CENTIFICATE**

FAAINSPECTOR FAA DESI ENTIFICATE HOLDER UNDER FANDS FAR 221, 127 o.126 FAR 100

**DATE NO NO**

### Page 17 (OCR)

Appendix 1 FAA FORM 8130-6 APPLICATION FOR A SPECIAL

AIRWORTHINESS CERTIFICATE - EXPERIMENIAL PREVIOUS U.S. CERTIFICATE OF AIRWORTHINESS ISSUED Form Approved O.M.B. No. 2120-0018 APPLICATION FOR Do only. Submit original onty to an authorized FAA Rep NSTRUCTIONS - Prim or type. Do not write in ded areas; these are for FA nativa. I additiona AIRWORTHINESS space is required, use an attachment. For special flight permits comp Sections

CERTIFICATE IMEGISTRATION MARK ZAIRCRAFT BUILDER'S NAME (MaNO) 2 AIRCRAFT MODEL DESIQNATION a YA SFR FAA CODING 1980 1500 cessn- 500

• AVCRAFT SEALAL N - ENGINE BULLDER'S NAME (060KO 7. ENGINE MODEL DESIGNATION 500-0001 LACL JT15D-1 & AUBER OF ENGINES a PROPELLER BUALDER'3 NAME (MONO) 18. PROPELLEN MODEL DESIONATION 11. AIRCRAFT IS (Check il applicable)

INVA N/A APPLICATION DO amj-

EN CERGOY) NORMAL UTILITY ACROBATIC TRANSPORT GLIDER BALLOON LENTED CLASS *OVEONAL (AND 0) CLASS N NO PEST CONTROL AERLAL SURVEYING 8 AERLAL ADVERTISI RESTRACTED (IndiCON OpENDO PATROLLING WEATHER CONTRO

• co LAGE OF CARDO OTHER (Spacity NESEARCH AND DEVELOMNENT AMATEURBUKT EXITIOn I RACINO OX CREW TRANNO IS MIKT. SURVEI

**TOSHOW CO NCE WITH FAR**

**PAIRS, ALTERATIONS, MAWTENANCE OR STORADE**

NSTRATION FLIGHTS . REGISTERED OWN # DEALER, CHECK HERS — lest K-42 Highway, P.O. Box 1977 Aircraft Co Kansas 67201

2. AVACRAFT CERTIFICATION BASIS (ChICK a MACANT ME, FICATION ON TYPE CEN and her MEET INNO - ON T 86-01-02 NECTIVES / CANO NACRAFT LISTING (QMO DOgO NU N/A 01(0) ENTAL TYPE CENTIRICATE LA ANTON I OCT 5TG MONSOON

**N/A N/A C. AVACRAFT OPERATION AND MAI NCE RECONOS**

**TOTAL AINFA HOLES**

52.0 22.0 Quality Control Mar A. D. Smith FAR PART 121 OR 127 C

**CATION OF CUM S CENTIFICATE**

FAA DESIONE FAROS FAN 121, 187 or 235 FAR 106 9

### Page 18 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

**AIRWORTHINESS CERTIFICATE - SPECIAL FLIGHT**

PERMIT FOR FERRY FLIGHT (Front Side)

•DOYI NORMAL UTILITY ACROBATIC TRANSPORT jOLIDEn BALLOON ПРЕСІ / ase come.

**MITED**

**CLABS I**

CLASS H AGRICULTURE ANO PEST CONTROL: 8 INERLAL ADVENTI RESTRICTED IM 10.00 PATROLLINO ¡WEATHER CONTROL

**CAMALADE OF CARDO OTHER I SEECHY)**

ANO DEVELOPMENT AMATEUR BUILT EXMBITION ENTALIE CREW TRAMMAG I MIKT. SURVEY ТО: E WITHFAR PAIRS. ALTERATIONS. MANTEI WCE OF STORAGE

**SPECIAL FLIGHT PERENT IS**

X OPERATION UM CERTFFICATED TAKE-OFF WEIGHT enviorme

**DELIVERING**

CUSTOMER DEN ST (Reverse Side)

TION OF AIRCRAFT NEOISTENED ON DOMESS P.O. BOX Weldon H. Jackson Maul, Haw wV.DER (0N) MODEL Piper PA 23-250

ONSTRATIONMARI 27-647 N4588P . DESCRIFTION OF FLIGHT CATION FLIGHTS • (CRECH 1) El Paso, Texs San Jose, California 31110X: 30 days C. CHEW RECUNED TO OPERATE THE ARORAFT AND ITS BOU X PROT

NORAFT DOES NOT MEET THE APPLICABLE A AS FOLLOWS Temporary Ferry Fuel System installed in accordance with FAA Form 337, "Major Repair and Alteration" dated 3/9/XX Gross weight not to exceed 110% of certificated maximum weight.

1. When the aircraft is in an overweight condition, the design cruise speed, Vc should not exceed 162 mph.

tank and 35 gallons in the aft tank. The fuel quantity should not exceed 140 gallons in the forward temporary placard installed in full view of the pilot. The sequence of use of the ferry fuel tanks shall be as shown by t P.CE 13/10/ XX Don Brown, Agent Rebrown 10

### Page 19 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A SPECIAL

**AIRWORTHINESS CERTIFICATE - SPECIAL FLIGHT PERMIT**

FOR FERRY FLIGHT (Front Side) DATICİ BALLOON

**ANTROLLNO**

•

**AMATELAOULT O MORN**

**CREW TRAMNO**

DUCTION FLIONT TESTING (Reverse Side) 4623 Mountainview Drive Robert F. Turner Naterloo. lova 50701 Bellanca S 11-12-2 4099 Water loo sume Maines.

DURATION Direct 2/23/21 Aircraft damaged in landing acciden Temporary repairs have been made for one flight to a repair shop at Moines - Dodge Airport, where permanent repairs vill be made.

Airspeed should not exceed .p.h.

Landing gear should not be retracted.

No passengers or cargo should CArT LET 1/06/30 LAND THU Robert F Turner Owner 11

### Page 20 (OCR)

Appendix 1 FAA FORM 8130-6 - APPLICATION FOR A

**SPECIAL AIRWORTHINESS CERIIFICATE**

**SPECIAL FLIGHT PERMIT FOR PRODUCTION**

FLIGHT TESTING (Front Side)

TALITY ACRORATIC TANORT OLDER BALLOON PEST CONTROL AERIAL SURVEYING • AERLAL ADVERT NESTECTED 11 PATROLLING WEATHER CONTRO

**E OR STO WAGI**

**OHT TESTING**

ULTIPLE (Reverse Side)

A MAMUFACTURER NAME NESS 509 Moreland Blvd.

ABC Aircraft Company Paloma, New York _20101

8. PRODUCTION BASIS (CA X MAODUCTION CERTIFICATE (GAs producion cars 101) PC 58

ECTION SYSTEM C GIVE QUANTITY OF CERTIFICATES REO RED FOR OPERATING NEEDS Five (5) DATE OF AU PLICATION LAME AND TITLE (PraH or type) EhdC.Burns 1/15/XX John C. Burns, President 12

### Page 21 (OCR)

Appendix 1 FAA-FORM 8130-6-APPLICATION FOR A MULTIPLE

AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR MNSTAUCTIONS - Print or type Do not write in shaded areas: these are for FAA use onty. Submit original onty to an authorized FAA Representative Madditional AIRWORTHINESS space is required, use an attachment. For special flight permits complete Sectioni CERTIFICATE Wand VI or VIl as applicable I REGISTRATION MARK 2AIACRAFT DULDERS NAME (MONO) 2, AIRCRAFT MODEL DESIONATION 2. YA MFR FAR CODINO N54321 Piper PA18A-150 1951 &. AMICRAFT SERLAL NO 6. ENGINE BUILDER'S NAME (Moke) 7. ENGINE MODEL DESIGNATION 18-3792 Lycoming 0-320 & MUNGER OF ENGINES 8. PROPELLER BUILDER'S NAME (MONO) 18. PROPELLER MODEL DESIGNATION 11. ANACRAFT 15 (Check 1/appirablo) Sensentich MADM • IPORT APPLICATION IS ME BY BRADE FOR: (Crock appucable Hams) AX STANDARD ARMORTHNESS CERTIFICATE (SCES CEpor) X NONMAL X UTALITY ACROBATIC TRANSPORT GLIDER BALLOON

• / SPECIAL AIMMORTHINESS CERTIFICATE (CRECh BRON LANTED CLASSI

**PROVISIONAL I**

**CLASS N ICLE TURE ANO FEST CONTROL 8 AERLAL SUAVEYAO D AERLAL ADVER**

PATROLLINO WEATHER CONTRO OTHER (Spcity)

**AMATEURBULT EXHIBITION CREW TRAN UKT. SURVEY**

**TO SHOW COM**

VCE OR STORAGE ESS OF e

**A FRODUCTION FLIGHT TESTING**

TRATION FLIENTS c • ABOVE Y A REGISTERED OWNER (AS • DEALER, CHECK HERE North Central Airplane Corp. Cutba t. 1 Box 502 . Minne 43692 NEET IGno No COME AD No. •and gion 1A2 Rev. 33, AR-7 Rev. 9 86-3-06 1(3} ENTAL TYPE CEN

**NA N/A C. AIRCRAFT OPERATION ANO MANTI ANCE RECONOS**

**TOTAL AIN HOURS**

MALIANCE WITO FAR 81.173 1205 N/A DATE OF A ANE AND TITLE (PrIM ON 8p0O.

a 10тa ¡CATE REQUESTED

ICATION OF CL ATE / FAn 121, 127 ом 186 FAR 200 13

### Page 22 (OCR)

3/26/87 AC 21-12A Appendix 1 FAA FORM 8130-6 - APPLICATION FOR AN

**AIRWOTHINESS CERTIFICATE FOR**

SURPLUS MILITARY AIRCRAFT M.э. NO. 2120-0 APPLICATION FOR Do not em sad areas: these ero for FAs

AIRWORTHINESS CERTIFICATE and Vl or Vill as a LNEGISTRATION MANK ZAMORAFT DULDENE NAME (MONO, ATION A TR. AFA FAA COS N61365 Cesana 310A 1959 AL NO a ENCINE BUILDER 3 NAME (MANO) 7. ENONE MODEL DERIOMATION 38001 Continental 0-470-M & MADER OF ENONES • PROPELLER BULLDER'S NAME (ECHO. DA PROPELLER MODEL DESIONATION 11. AIRCRAFT IS / CROCH 11 a /cabo Hartzall HC82XE-2 •PORT UTILITY ACROBATIC | ECLAL AMORTHINESS CERTIFICATE /CHOA.

**LENTED**

**I TESTIMO MUTILE.**

A REGISTERED OWNER (AS I ard D. Pratt 12. hust Louis 41366

**CRAFT CENTIFICATION BASIS (CASCH EA**

ANACATION OR TIPE CENTVICATE DATI 3A10 ReV. 51 85-01-01 CRAFT LISTINO (OHO PEDO a N/A

ITION AND MAINTEMANCE NECORDE TOTAL 9,000 10/28/XX Howard D. Pratt, Owner Namerd A Pratt

PICATED NEP 4326 Chief In FAA : AFAR DE PARO FARE. FAR N 14

### Page 23 (OCR)

Appendix 2 FAA Regional Office to Contact When the Address of the Appropriate FAA Flight Standards or Manufacturing Inspection District Office Is Not Known.

Location of Applicant Alaska, Aleutian Islands Iowa, Kansas, Missouri, Nebraska New York, Delaware, district of Columbia, Pennsylvania Maryland, New Jersey, West Virginia Virginia, Canada Europe, Africa, Middle East, Iceland, Azores Address of FAA Regional Office Director, FAA 701 'C' Street, Box 14 Anchorage, Alaska 99513 Director, FAA 601 E. 12th Street Kansas City, Missouri 64106 Director, FAA JFK International Airport Jamaica, New York 11430 Assistant Administrator, FAA 15 Rue de la Loi B-1040 Brussels, Belgium Attn: AEU-100 Illinois, Indiana, Michigan, Director, FAA Minnesota, Ohio, Wisconsin, 2300 E. Devon Avenue North Dakota, South Dakota Des Plaines, Illinois 60018 Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Washington, Oregon, Idaho, Montana, Wyoming, Utah, Colorado Hawaii, Pacific Ocean area west of continental U.S. and east of Bangladesh and India including all free nations south and east of China Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Caribbean Area, Central America, Puerto Rico, Canal Zone, Virgin Island, Swan Island Director, FAA 12 New England Executive Park Burlington, Massachusetts 1803 Director, FAA 17900 Pacific Highway South C-68966 Seattle, Washington 98168 Manager, Flight Standards District Office 13 Honololu International Airport Air Service Corporation Building 218 Lagoon Drive, Room 215 Honolulu, Hawaii 96819 Director, FAA P.O. Box 20636 Atlanta, Georgia 30320 Arkansas, Louisiana, New Mexico, Director, FAA oklahoma, Texas, Mexico P.O. Box 1689 Fort Worth, Texas 76101 Arizona, California, Director, FAA Nevada, Wake Island, Samoa, P.O. Box 92007 Guam Worldway Postal Center Los Angeles, California 0009 1

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