U.S. Department of Transportation Federal Aviation Administration Advisory Circular Subject: APPLICATION FOR U.S. Date: 11/06/01 AC No: 21-12B AIRWORTHINESS CERTIFICATE, Initiated by: AIR-210 Change:
FAA FORM 8130-6 ___________________________________
1. PURPOSE. This advisory circular (AC) provides guidance and information on the preparation and submittal of Federal Aviation Administration (FAA) Form 8130-6, Application for Airworthiness Certificate. This application is completed to obtain an airworthiness certificate and for an amendment or modification to a current airworthiness certificate. Form 8130-6 is not required for the issuance of a replacement airworthiness certificate.
2. CANCELLATION. AC 21-12A, Application for U.S. Airworthiness Certificate, FAA Form 8130-6 (OMB 2120-0018), dated March 26, 1987, is cancelled.
3. PRINCIPAL CHANGES.
a. Instructions for completing Form 8130-6 have been updated and revised to reflect minor changes to the new version of Form 8130-6, dated May 2001.
b. Appendix 1, Listing of FAA Regional Offices, has been removed and reference information for contacting these offices has been added to the AC.
c. Title 14 Code of Federal Regulations (14 CFR) references have been revised and the text reworded for clarification.
4. RELATED READING MATERIAL.
a. Title 14 Code of Federal Regulations:
(1) 14 CFR part 21, Certification Procedures for Products and Parts (part 21).
(2) 14 CFR part 39, Airworthiness Directives (part 39).
(3) 14 CFR part 43, Maintenance, Preventive Maintenance, Rebuilding, and Alteration (part 43).
(4) 14 CFR part 45, Identification and Registration Marking (part 45).
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(5) 14 CFR part 47, Aircraft Registration (part 47).
(6) 14 CFR part 91, General Operating and Flight Rules (part 91).
b. FAA Order 8130.2, Airworthiness Certification of Aircraft and Related Products.
c. FAA Advisory Circulars:
(1) AC 20-27, Certification and Operation of Amateur-Built Aircraft.
(2) AC 20-65, U.S. Airworthiness Certificates and Authorization for Operation of Domestic and Foreign Aircraft.
(3) AC 20-126, Aircraft Certification Service Field Office Listing.
(4) AC 21-4, Special Flight Permits for Operation of Overweight Aircraft.
(5) AC 21-37, Primary Category Aircraft.
(6) AC 39-7, Airworthiness Directives.
5. INFORMATION. The current version of Form 8130-6 (dated May 2001) may be obtained free of charge at any Manufacturing Inspection District Office (MIDO) or Flight Standards District Office (FSDO). Applicants may continue to use Form 8130-6 (dated November 1988) while the newer form is distributed for availability. A geographic listing of the location, phone number, and FAX number of the nearest MIDO can be found in AC 20-126, Aircraft Certification Service Field Office Listing. Similar information for FSDO’s can be found by accessing the FAA website at: www.faa.gov.
6. INSTRUCTIONS FOR COMPLETING FORM 8130-6. The applicant, or the applicant’s agent, should complete sections I through IV when submitting an application for an airworthiness certificate. If submitting an application for a special flight permit, only sections II and VI, or II and VII, as applicable, are required. The following instructions apply to the corresponding items on the form:
a. Section I. Aircraft Description.
NOTE: Do not complete this section when application is being submitted for a special flight permit.
(1) Registration Mark. Enter the United States (U.S.) nationality designator letter “N” followed by the registration marks as shown on the aircraft registration certificate. (Reference 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 section 45.13(a)(1).)
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(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.
(b) For aircraft built from spare and/or surplus parts, the aircraft make is that of the Type Certificate (TC) holder (as it appears on the applicable aircraft listing, specification, or Type Certificate Data Sheet (TCDS)) together with the name of the builder (for example, Bell-Jackson).
(c) For surplus military aircraft (not assembled from spare and/or surplus parts), the builder’s name will be as listed on the TCDS.
(3) Aircraft Model Designation. Enter the model designation as shown on the aircraft ID plate.
Trade names should not be used. (Reference section 45.13(a)(2).)
(a) For amateur-built aircraft, the model may be any arbitrary designation selected by the builder. For aircraft purchased as a kit, the model designation assigned by the kit manufacturer should be used.
(b) For aircraft built from spare and/or surplus parts, the model designation will be the civil model shown on the TCDS to which the applicant shows conformity.
(c) For surplus military aircraft having a civil model counterpart, enter the civil model designation along with the military model designation in parentheses. If the TC was issued under section 21.27, the military model designation becomes the civil model designation.
(d) For surplus military aircraft type certificated under the provisions of section 21.25(a)(2) in the restricted category, only the military designation will be entered.
(4) Year of Manufacture. Enter the year of manufacture if shown on the aircraft ID plate or as reflected in the aircraft’s records.
(a) For aircraft eligible for standard airworthiness certificates, the year of manufacture is the date (entered by the manufacturer) the aircraft was completed and met the FAA-approved type design data. Inspection records reflect the date of aircraft completion.
(b) For aircraft other than the above, the year of manufacture is the date entered by the builder in the inspection records or logbook, establishing that the aircraft is airworthy and eligible for the certificate requested.
(5) Aircraft Serial Number. Enter the serial number as shown on the aircraft ID plate.
(Reference section 45.13(a)(3).)
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(a) For amateur-built aircraft fabricated and assembled from the builder’s own design, the serial number may be any arbitrary number assigned by the builder. For any aircraft fabricated and assembled from a kit or plans, the aircraft identification information provided by the kit manufacturer or plans designer should be used.
(b) For aircraft built from spare and/or surplus parts, enter the serial number assigned by the builder. That number should not be confused with the serial numbers assigned by an original manufacturer who builds the same type 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 serial number to provide positive identification.
(c) For surplus military aircraft, enter the manufacturer’s civil serial number. The military serial number should be placed in parentheses following the civil serial number. If no civil serial number exists, enter the military serial number.
(6) Engine Builder’s Name (Make). The engine make is the name of the manufacturer as it appears on the engine ID plate. Abbreviations may be used (for example, “P&W,” “G.E.,” etc.). When engines are not installed, as in the case of a glider or balloon, enter “not applicable” or “N/A.”
(Reference section 45.13(a)(1).)
(7) Engine Model Designation. When engine(s) are installed, enter the complete designation as shown on the engine ID plate (for example, “O-320-A1B,” “PT6A-20A,” “CFM-56-3C-1,” etc.).
(Reference 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 marking. Enter “not applicable” or “N/A” if propellers are not installed.
(Reference section 45.13(a)(1).)
(10) Propeller Model Designation. When applicable, enter the model designation as shown on the propeller identification marking. For amateur-built aircraft having a propeller not identified in accordance with section 45.13(a)(1), enter the propeller diameter times (X) pitch in lieu of propeller model designation. (Reference section 45.13(a)(2).)
(11) Aircraft is Import. This block should be checked only if the aircraft was manufactured outside the U.S. and certified under the provisions of section 21.29, and the applicant is seeking airworthiness certification under the provisions of section 21.183(c).
b. Section II. Certification Requested. The following paragraphs refer to the applicable 14 CFR for standard and special airworthiness certificates used to aid in the completion of Form 8130-6 (see Appendix 1, figures 1-17, for illustrated examples of a completed Form 8130-6).
(1) Item A. Standard Airworthiness Certificate. This certificate is issued to type certificated aircraft in the normal, utility, acrobatic, transport, commuter, and manned free balloon categories; and
Par 6 Page 5 for special classes of aircraft. Special class aircraft include gliders, airships, and other non-conventional aircraft. Special class application is indicated by marking the standard and other blocks (section II (A) of the application), and entering the type, (for example, glider, very light aircraft, airship, etc.) in the blank space directly above the category blocks. For aircraft type certificated prior to the adoption of categories, enter in the open space above the category blocks, the basis for certification as shown in that aircraft’s TCDS or specification sheet (for example, Category N/A - Certification basis CAR 04 A (Civil Air Regulations part 4a)). Applicable regulations are as follows:
(a) Section 21.183(a), New aircraft manufactured under a production certificate.
(b) Section 21.183(b), New aircraft manufactured under a type certificate only.
(c) Section 21.183(c), Import aircraft.
(d) Section 21.183(d), Other aircraft.
(2) Item B. Special Airworthiness Certificate. This certificate is issued to aircraft not meeting the requirements for a standard airworthiness certificate. Special airworthiness certificates are identified as primary, limited, provisional, restricted, experimental, and special flight permit.
Applicable regulations are as follows:
(a) Primary Airworthiness Certificate.
1. Section 21.184(a), New primary category aircraft manufactured under a production certificate.
2. Section 21.184(b), Imported aircraft.
3. Section 21.184(c), Aircraft having a current standard airworthiness certificate.
4. Section 21.184(d), Other aircraft.
(b) Limited Airworthiness Certificate. Section 21.189, Issue of airworthiness certificate for limited category aircraft.
(c) Provisional Airworthiness Certificate.
1. Section 21.221, Class I provisional airworthiness certificates. (May be issued for all categories.)
2. Section 21.223, Class II provisional airworthiness certificates. (Transport category only.)
(d) Restricted Airworthiness Certificate.
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1. Section 21.185(a), Aircraft manufactured under a production certificate or type certificate only.
2. Section 21.185(b), Other aircraft (surplus U.S. military aircraft or one previously type certificated in another category).
3. Section 21.185(c), Import aircraft (type certificated in the restricted category in accordance with section 21.29).
(e) Experimental Certificate.
1. Section 21.191(a), Research and development.
2. Section 21.191(b), Showing compliance with regulations.
3. Section 21.191(c), Crew training.
4. Section 21.191(d), Exhibition.
5. Section 21.191(e), Air racing.
6. Section 21.191(f), Market surveys.
7. Section 21.191(g), Operating amateur-built aircraft.
8. Section 21.191(h), Operating kit-built aircraft (primary category aircraft assembled by a person(s) without the supervision and quality control of the production certificate holder).
(f) Special Flight Permit.
1. Section 21.197(a)(1), Flying the aircraft to a base where repairs, alterations, or maintenance are to be performed, or to a point of storage.
2. Section 21.197(a)(2), Delivering or exporting the aircraft.
3. Section 21.197(a)(3), Production flight testing new production aircraft.
4. Section 21.197(a)(4), Evacuating aircraft from areas of impending danger.
5. Section 21.197(a)(5), Conducting customer demonstration flights in new production aircraft that have satisfactorily completed production flight tests.
6. Section 21.197(b), Operation of an aircraft at a weight in excess of its maximum certificated takeoff weight.
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(3) Item C. Multiple Airworthiness Certificates. These certificates are issued to an applicant in the restricted category and one or more other categories except the primary category. Section 21.187 identifies the requirements an applicant must comply with before multiple airworthiness certificates are issued.
c. Section III. Owner’s Certification. Do not complete this section when application is being submitted for a special flight permit.
(1) Item A. Registered Owner.
(a) Enter the name and address exactly as shown on the aircraft registration certificate.
(Reference part 47.)
(b) If Dealer, Check Here. This block should be checked ONLY if the aircraft is registered under an aircraft dealer’s aircraft registration certificate. (Reference part 47, subpart C.)
(2) Item B. Aircraft Certification Basis.
(a) Aircraft Specification or TCDS and/or Aircraft Listing Block. This item should be completed when an application is submitted for a standard, primary, limited, provisional, restricted, or multiple airworthiness certificates.
(b) When application is submitted for multiple airworthiness certificates, the certification basis for each certificate should be entered.
(c) When a TCDS or specification for a new aircraft or model HAS BEEN APPROVED BUT NOT PUBLISHED, enter the date of approval, TC or specification number, and the word “preliminary.” This item is not applicable when submitting an application for an experimental certificate, therefore, “N/A” should be entered.
(d) Airworthiness Directives. This block should be checked to indicate compliance with all applicable Airworthiness Directives (AD). Enter the number of the last biweekly supplement to the Summary of Airworthiness Directives available as of the date of application. (For example, Biweekly Supplement 97-06 was published on March 24, 1997.)
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 airworthiness certification categories are used to identify the product affected. (Reference AC 39-7.)
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(e) Supplemental Type Certificate (STC). This block is applicable to all standard airworthiness certification; and special airworthiness certification in the restricted, limited, provisional, and primary categories, and should be completed at the time of application. The number of each installed STC should be entered. If more space is required, an attachment may be used.
(Reference part 21, subpart E.)
(3) Item C. Aircraft Operation and Maintenance Records.
(a) Maintenance records shall comply with section 91.417. This block is applicable to all aircraft and should be checked to indicate that the recordkeeping requirements of section 91.417 have been met. For example, section 91.417(a)(2)(i), requires the total service time of the airframe, each engine, propeller, and rotor. Compliance to section 91.417(a)(2)(ii), requires a maintenance record of the current status of life-limited parts of each airframe, engine, propeller, rotor, and appliance. All entries should be written in English and not with erasable materials such as lead/carbon pencils.
(b) Total Airframe Hours. The total service time of the aircraft, including production flight test time, should be entered.
(c) Experimental Only. When submitting an application for renewal of an experimental certificate, or when requesting a change back to a standard certificate, the hours flown since the previous 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.
(4) Item D. Certification. If the signature is the owner’s agent, a notarized letter from the registered owner authorizing the agent to act on the owner’s behalf is required.
NOTE: The term AIRWORTHY, as stated in FAA Order 8130.2, Airworthiness Certification of Aircraft and Related Products, means (1) the aircraft conforms to its type design and (2) the aircraft is in a condition for safe operation. In the case of an application for an aircraft in the experimental category, only the “AIRCRAFT IS IN A CONDITION FOR SAFE OPERATION” portion of the definition would apply for the purpose of this application.
d. Section IV. Inspection Agency Verification. This section should be completed only if the application is for a standard airworthiness certificate in accordance with section 21.183(d). This section should be left blank for all other certification actions.
e. Section V. FAA Representative Certification. Applicants should not make any entries in this section. This information will be entered by the FAA Inspector/Designee who 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 section 21.197(a)(3).)
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g. Section VII. Special Flight Permit Purposes other than Production Flight Test.
(1) Item A. Description of Aircraft. 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. Enter the present location of the aircraft in the From box and the aircraft’s intended destination in the To box.
(a) The Via block should contain the name of an airport or city at some intermediate flight point to provide a general description of the route flown. For example, a flight from Kansas City, Missouri to Dallas, Texas may be flown via Wichita, Kansas and Oklahoma City, Oklahoma.
(Reference section 21.199(a)(2).)
(b) The Duration entry should reflect the overall duration of the special flight permit.
Factors such as fueling stops, weather conditions, overnight stops, or any other reasonable condition should be given consideration when establishing the duration. (Reference section 21.199(a)(2).)
(3) Item C. Crew Required to Operate the Aircraft and its Equipment. Self-explanatory.
(4) Item D. The Aircraft Does Not Meet the Applicable Airworthiness Requirements as Follows. This entry should contain in detail the conditions, if any, in which the aircraft does not comply with the applicable airworthiness requirements. (Reference section 21.199(a)(4).)
(5) Item E. The Following Restrictions are Considered Necessary for Safe Operation. This entry should contain in detail any restrictions the applicant considers necessary for safe operation of the aircraft (for example, reduced airspeed or operating weight, turbulence avoidance, crew limitations or qualifications, etc.). After review of the application, the FAA may prescribe additional conditions and/or limitations deemed necessary for safe operation. (Reference section 21.199(a)(5) and (6).)
(6) Item F. Certification. Self-explanatory.
h. Section VIII. Airworthiness Documentation. This section will be completed by the FAA Inspector/Designee who inspects the aircraft and issues the airworthiness certificate, and is not required when the applicant is submitting an application for a special flight permit.
7. INSTRUCTIONS FOR SUBMITTING THE COMPLETED FAA FORM 8130-6. When the applicant has completed the applicable sections and has signed the Form 8130-6, it should be submitted to the local MIDO or FSDO. The nearest MIDO or FSDO location can be determined by referencing the information in paragraph 5 of this AC. Other material may be required by the regulations for the final airworthiness certification. In the case of a manufacturer holding a FAA production approval, an application may be submitted to an authorized Designated Airworthiness Representative or Designated Manufacturing Inspection Representative.
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8. HOW TO OBTAIN THE REFERENCED PUBLICATIONS.
a. The CFR and those ACs for which a fee is charged may be obtained from the Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. A listing of the CFR and current prices is located in AC 00-44, Status of Federal Aviation Regulations, and a listing of all ACs is located in AC 00-2, Advisory Circular Checklist.
b. To be placed on the FAA’s mailing list for free ACs, contact: U.S. Department of Transportation, Subsequent Distribution Office, SVC-121.23, Ardmore East Business Center, 3341Q 75th Avenue, Landover, MD 20785.
c. The FAA website at: www.faa.gov.
/S/ Frank P. Paskiewicz Manager, Production and Airworthiness Division, AIR-200
Appendix 1 APPENDIX 1. SAMPLES OF FORM 8130-6, APPLICATION FOR AIRWORTHINESS
CERTIFICATE FIGURE 1. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – VERY LIGHT AIRCRAFT PRODUCED UNDER SECTION 21.183(a) (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II . CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st certificate CERTIFICATED R EPAIR STATION (Give CertificateCERTI FI CATED MECHANI C (Give AI RCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the las t AD SUPPL EM ENT avai lable in the bi weekl y ser ies a s of the d ate o f app lication) 96- 23 issued or re newed) 0 N o.)
Revision No.)
A2W I Rev-1 14 C F R par t 121 C ER T IFIC A TE H O LD ER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIVE
CERTIFICATION I. AIRCRA FT DESC RIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTION AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N 18C E APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AI RCRAFT BU I LDER'S NAME (M ake) Lite -Fligh t C orp FAA CODI NG3. AI RCRAFT MODEL DESI GNATI ON L F-1-A
4. YR . M FR .
7. ENGINE MODEL DE SIGNATION 912
10. PRO PELLER MODEL DESIG NATION Go od-1 IM POR T
11. AIRC RAFT IS (Check if appl icable) DATE DI STRI CT OFFI CE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Lite F light Corp
ADDRESS 1801 Airpo rt Rd W ichi ta, KS 67 209 B. AI RCRAFT CERTI FICATI ON BASI S (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AI RCRAFT OPERATI ON AND MAI NTENANCE RECORDS
CHECK I F RECORDS I N
COMPLI ANCE WI TH 14 CF R se ctio n 91 .417
TOTAL AI RFRAME HOURS
2.0 3
DATE OF APPLICATION 11/2 5/98 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of the a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered w it h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce w ith Title 49 of th e U nited Sta tes Co de 441 01 et se q . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craft ha s be en i nspe cted and is airw orth y an d el igib le for the a irwo rthi ness cer tifi cate requ ested.
A. THE AI RCRAFT DESCRI BED ABOVE HAS BEEN I N SPECTE D AND FO UND AI RWOR THY BY: (Complet e t his sect ion only if 14 CFR part 21 . 183( d) app lies).
NAME AND TI TLE (Print or t ype) K.D. Go od, D irector QA
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal 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.
B. Insp ecti on for a spe cial fli ght perm it u nder Sec tion VII wa s c ond ucted by:
6. ENGINE BUILDER 'S NAME (M ake) R otax
9. PROPELLER BUI LDER'S NAME (M ake) W o od B uilt
5. AIRCR AFT SER IAL NO.
LF 010
8. NUMBER OF ENGINES One
I F DEALER, CHECK HERE AI RCRAFT LI STING (Give page number(s)) N/ A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/ A AI R CRAFT MANU FACTURER (Give name or f irm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
OM B. N o. 212 0-0 018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , then com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PR OVIS ION AL (Indicate class) RESTRI CTED (Indi cate opera tion( s) to be c ond ucted)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATRO LLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAI NI NG
EXH IBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATI ON FLI GHTS
PRODUCTI ON FLI GHT TESTI NG
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF I MPENDI NG DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AI R RACI NGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond ucted) OTHER (Specify) OPERATING (Prim ary Category) KI T BUI LT AI RCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODI FI CATI ON OF CURRENT AI RWORTHI N ESS CERTIFICATE
CERTI FI CATE HOLDER UNDER Very Light Aircraft X OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 6 5 2
Appendix 1 FIGURE 2. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – AIRCRAFT PRODUCED IN THE
TRANSPORT CATEGORY (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) N/A No.)
Revision No.)
A16W E 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. F AA
REPRES ENTATIV E
CERTIFICATION I. AIRCRAFT DESC RIPTIONIII. OWNER'S CERTIFICATI ON IV. INSPECTION AGENCY
VERIFICATION A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK NI2 345 APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake)
B OEING FAA CODING3. AIRCRAFT MODEL DESIGNATION 73 7-20 0
4. YR. M FR.
19 68
7. ENGINE MODEL DESIGNATION JT8D-9
10. PRO PELLER MODEL DESIG NATION
N/A IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Shortha ul A irli nes, Inc
ADDRESS 111 Airpo rt W ay, St L ouis , M i ssou ri 5 8010 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS 8: 45 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq. and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) John Doe , V P O per ati ons
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal 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.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) Pra tt & W hi tney
9. PROPELLER BUILDER'S NAME (M ake) N/A
5. AIRCR AFT SER IAL NO.
19 714
8. NUMBER OF ENGINES 2
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-00180
NORMAL UTILITY ACROBATIC X TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE W ITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 6 2 5