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.
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
(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.
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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
(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.
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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
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
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
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
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