Appendix D Figure D-2. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Standard - New Aircraft Produced in the Transport Category (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION . YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO N12345 6. ENGINE BUILDER'S NAME (Make) The Boeing Company 7. ENGINE MODEL DESIGNATION 737-800 2010 19714 CFM International CFM56-7B26
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable) 2 N/A N/A IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) NORMAL UTILITY ACROBATIC V TRANSPORT BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate tems)
PRIMARY LIGHT-SPORT (nacate Class) Airplane Power-Parachute Weight-Shift-Control L Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL AERIAL SURVEY AERIAL ADVERTISING 3 RESTRICTED (Indicate operations) to be conducted) FOREST (Wildlife conservation) 5 PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR _ OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indicate operations) to be conducted) OPERATING 8B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthines ertificate under § 21.19 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT pinacate EVACUATE FROM AREA OF IMPENDING DANGER operation to be conducted, then complete Section VI or Vill as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE→
NAME ADDRESS Shorthaul Airlines, Inc. 111 Airport Way, St. Louis MO 58010 B. AIRCRAFT CERTIFICATION BASIS (Check apolcable blocks and complete ems as indicated) III. OWNER'S CERTIFICATION Revision No) A16WE Rev 45 AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and AIRWORTHINESS DIRECTIVES (Checkif all applicable ADs are complied with and give the number 2010-O SUPLEMENT alone in the weekly senes as it the date of plication) AIRCRAFT LISTING (Give page number (s)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 80 Terences D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in ccordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for th airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 02/23/2010 John Doe, Vice President Jake Dar A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 211830) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GNe CERTIFICATED MECHANIC (Give Certiticate No.) CERTIFICATED REPAIR STATION (Give Certificate AGENCY AIRCRAFT MANUFACTURER (GIve name or fir Certificate No.)
DATE TITLE SIGNATURE (Check ALL applicable block Rems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE CERTIFICATION A. I find that the aircraft described in Section I or VIl meets requirements for B. Inspection for a special flight permit under Section VII FAA INSPECTOR AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-3
Appendix D Figure D-3. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Standard
- Used Aircraft in the Transport Category (No Previous U.S. Airworthiness Certificate Issued) (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VIl as applicable Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO N12345 6. ENGINE BUILDER'S NAME (Make) Douglas 7. ENGINE MODEL DESIGNATION DC-6A 1952 43218 Pratt & Whitney CB-16
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS /Check if applicable 4 Hamilton Standard 43E60-300 IMPORT APPLICATION IS HEREBY MADE FOR: (Cheek applicable items) A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate categoy) NORMAL UTILITY ACROBATIC V TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate fems)
PRIMARY LIGHT-SPORT (Indicate Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED
CLASS T PROVISIONAL (indicate class) CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING 3 RESTRICTED (Indicate operations) FOREST (Wildlife conservation) PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENT AL (Indicate operations) to be conducted) OPERATING LIGHT-SPORT 8B Operating Light-Sport Kit-built 8C Operating light-sport previously issued special light-sport category airworthines ertificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT (Indicate EVACUATE FROM AREA OF IMPENDING DANGER Section VI or Vil as appicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS C B MULTIPLE IPLE AIRWORTHINESS (Check ABOVE "Restricted Operatior? and "Standard" or Limited" as applicable) A REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE→
NAME ADDRESS Tiger Aviation Corp. 234 Jane Ave., Jackson, MS 78965 B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete tems as indicated) III. OWNER'S CERTIFICATION Revision No./ 63A Rev. 26 AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and AIRWORTHINESS DIRECTIVES (Check it all applicable ADs are complied with and give the number of the last AD SUPPLEMENT available in the biweekly series as of the date of application 2010-02 AIRCRAFT LISTING (Give page number(s) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A SA2-414; SA2-567; SA4-532; SA2231 C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 12347 D. CERTIFICATION - T hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 01/31/2010 John Doe, President Gater Dar A THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183Yd) apples) IV. INSPECTION 14 CFR part 121 CERTIFICATE HOLDER (Give CERTIFICATED MECHANIC (Give Certificate No.)
AGENCY Certificate No.) AIRCRAFT MANUFACTURER (Give name or firm)
ITLE SIGNATURE 02/23/2010 David E. Jones, Manager Dorrid E Guncs (Check ALL applicable block Items A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE A. I find that the aircrat described in Section I or VIl meets requirements for B. Inspection for a special flight perit under Section VII AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE CERTIFICATION was conducted by: FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-4
Appendix D Figure D-4. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Standard - Import Glider (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION . YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO N53B 6. ENGINE BUILDER'S NAME (Make) Alexander Schleicher GmbH 7. ENGINE MODEL DESIGNATION AS-K13 2002 501 N/A N/A
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable
N/A N/A / IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) • Glider A 1/STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) / NORMAL UTILITY COMMUTER BALLOONY OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate ters)
PRIMARY LIGHT-SPORT (nacate Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED PROVISIONAL (increate cess) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL AERIAL SURVEY AERIAL ADVERTISING RESTRICTED (indicate ope FOREST (Wildlife conservation) PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR | 7 OPERATING (Primary Cafegory) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103,1 EXPERIMENTAL (Indicate:
to be conducted) OPERATING 8B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthiness certificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT (indieate EVACUATE FROM AREA OF IMPENDING DANGER Section VI or Vill as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 15 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS C 6 MULTIPLE IPLE AIRWORTHINESS (Check ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE
NAME ADDRESS Elmer E. Jones 1601 E. 6th Street, San Diego, CA 95472 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete items as indicated) AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and AIRWORTHINESS DIRECTIVES (Check it all applicable ADs are complied with and give the number Revision No / G15EU of the last AD SUPPLEMENT available in the biweekly series as of the date of application) 2002-12 AIRCRAFT LISTING (Give page numbers)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC Incorporated) N/A
• AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 320 or renewed) D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 06/20/2002 Elmer E. Jones, Owner Elmer E Ganes A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183(d) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GNe CERTIFICATED MECHANIC (Give Certificate No.) CERTIFICATED REPAIR STATION (Give Certiticate AGENCY AIRCRAFT MANUFACTURER (GNe name or firm) Certificate No.)
DATE TITLE SIGNATURE (Check ALL applicable block Rems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE A. I find that the aircraft described in Section I or VIl meets requirements for AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE B. Inspection for a special flight permit under Section VII CERTIFICATION was conducted by: FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-5
Appendix D Figure D-5. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Standard - Surplus U.S. Military Aircraft Under § 21.183(d) (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO NS4562 6. ENGINE BUILDER'S NAME (Make) Hughes Aircraft Company 7. ENGINE MODEL DESIGNATION 369A (OH-6A) 1966 1332 Allison Engine Company 250-C10B
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check it applicable)
N/A N/A IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) I NORMAL UTILITY COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate fems)
PRIMARY LIGHT-SPORT (nacate Class) Airplane Power-Parachute Weight-Shift-Control •Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING 3 RESTRICTED (Indicate operations) to be conducted) FOREST (Wildlife conservation) 5 PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR _ OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indicate operations) to be conducted) OPERATING 8B Operating Light-Sport Kit-built LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthiness certificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT pinacate EVACUATE FROM AREA OF IMPENDING DANGER operation to be conducted, then complete Section VI or Vill as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTiON FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE
NAME ADDRESS Helicopter Operators, Inc. 234 Perimeter Drive, Stackton CA 94044 B. AIRCRAFT CERTIFICATION BASIS (Check apolcable blocks and complete ems as indicated) III. OWNER'S CERTIFICATION Revision No) H3 WE Rev. 2 AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and AIRWORTHINESS DIRECTIVES (Checkif all applicable ADs are complied with and give the number 2010-02 PLEMENT a alane in the weeky senes as the date of pohion) AIRCRAFT LISTING (Give page number (s)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 2852 3 Terences 14 CFR section 91.417 D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in ccordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 01/31/2010 James, J. Jones, General Manager James Janes A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.1830) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GNe CERTIFICATED MECHANIC (Give Certiticate No.) CERTIFICATED REPAIR STATION (GiVe Certiticate AGENCY AIRCRAFT MANUFACTURER (Gie name or trm) MD Helicopters, Inc. Certificate No.)
DATE TITLE SIGNATURE 02/23/2010 Richard Martin, Manager, Quality Assurance Rickard Mastir (Check ALL applicable block items A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE A. I find that the aircraft described in Section I or VIl meets requirements for AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE CERTIFICATION B. Inspection for a special flight permit under Section VII nas conaucted by. FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-6
Appendix D Figure D-6. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Standard - Other, JAR/VLA (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION , YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO N7569K 6. ENGINE BUILDER'S NAME (Make) Aero Ltd 7. ENGINE MODEL DESIGNATION AT-3R100 2010 AT3-999 Bombardier-Rotax 912S2
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) GT ELICHE 10. PROPELLER MODEL DESIGNATION GT-2/173/VRR-FW101SRTC • MPORT 1. AIRCRAFT IS (Check if applicable) APPLICATION IS HEREBY MADE FOR: (Check applicable items) JAR/LA A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) NORMAL UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON Y OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate tems)
PRIMARY LIGHT-SPORT (nacate Class) Airplane Power-Parachute Weight-Shif-Control •Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL AERIAL SURVEY AERIAL ADVERTISING 3 RESTRICTED (Indicate operations) to be conducted) FOREST (Wildlife conservation) 5 PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR 7 _ OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indicate operations) to be conducted) OPERATING _₴B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthines ertificate under § 21.19 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT pinacate EVACUATE FROM AREA OF IMPENDING DANGER operation to be conducted, then complete Section VI or Vill as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE→
NAME ADDRESS I. R. Applicant 14 David Rd., Nashville, TN 37243 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION B Revision No) A61CE AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and 1S (Check applicable blocks and complete items as indicated) AIRWORTHINESS DIRECTIVES (Checkif all applicable ADs are complied with and give the number 2010-1 SUPPLEMENT avaNal in the weekly senes as it the date of apocation) AIRCRAFT LISTING (Give page number (s)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 132 Terences 14 CFR section 91.417 D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in ccordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for th airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 09/23/2010 I. R. Applicant 2. R Applicant A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183Y0) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GNe CERTIFICATED MECHANIC (Give Certiticate No.) CERTIFICATED REPAIR STATION (Give Certificate AGENCY AIRCRAFT MANUFACTURER (GIve name or fir Certificate No.)
DATE TITLE SIGNATURE (Check ALL applicable block Rems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE CERTIFICATION A. I find that the aircraft described in Section I or VIl meets requirements for B. Inspection for a special flight permit under Section VII was conducted by: FAA INSPECTOR AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-7
Appendix D Figure D-7. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Primary Category Aircraft Certificated Under § 21.184(a) (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable Administration
1. REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) • AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO N2EZ 6. ENGINE BUILDER'S NAME (Make) Flight Corp. 7. ENGINE MODEL DESIGNATION F-C-!A 1991 F0002 TCM IO-360-ES
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable) McCauley 2A34C209 IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) NORMAL UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items)
Y PRIMARY LIGHT-SPORT (Indicate Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED PROVISIONAL (Indicate class) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING RESTRICTED (Indicate operationy's) o be conducted FOREST (Micide conservation) | PATROLLING WEATHER CONTROL OTHER (Specify) RESEARCH AND DEVELOPMENT | 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indicate operations) to be conducted) OPERATING 8B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthiness pertificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT (Indicate EVACUATE FROM AREA OF IMPENDING DANGER Section VI or Vil as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE →
NAME ADDRESS Flight Corp. 10 Lane Ave., Doby, TX 78907 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION BASIS (Chec Revision No. CE785 AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and and complete Rems as indicated) AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number 21010-O2UPPLEMENT arable in the bely senes as of the cat of apocation) AIRCRAFT LISTING (Give page number(5)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC Incorporated) N/A
AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91 417 2 or renewed) D. CERTIFICATION - T hereby certity that I am the registered owner (or his agent) of the aircraft descnbed above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 at seg and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 01/27/2010 Joe Quality, Director, Q.A. Gae Quality A THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section ony if 14 CFR part 21.183(g) apples) IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (Give CERTIFICATED MECHANIC (Give Certificate No.) CERTIFICATED REPAIR STATION (Give Certificate AGENCY AIRCRAFT MANUFACTURER (Give name or tim) Certificate No.) No.)
DATE SIGNATURE (Check ALL applicable block tems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE A. I find that the aircratt described in Section I or VIl meets requirements for AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE B. Inspection for a special flight permit under Section VII CERTIFICATION was conducted by: FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-8
Appendix D Figure D-8. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Light-Sport Category with Type-Certificated Installations (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) . AIRCRAFT MODEL DESIGNATION , YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO. N12LSA 6. ENGINE BUILDER'S NAME (Make) Renegade 7. ENGINE MODEL DESIGNATION Falcon LS 2010 RL 122701-001 Lycoming Engines 10-233
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION . AIRCRAFT IS (Check if applicable) Helix Carbon GmbH H25F1,30mL-08-2 IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate tems)
PRIMARY 9 / LIGHT-SPORT (nacate Class) * Airplane Power-Parachute Weight-Shif-Control • | Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING 3 RESTRICTED (Indicate operations) to be conducted) FOREST (Wildlife conservation) 5 PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR 7 _ OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indicate operations) to be conducted) OPERATING 8B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthines: certificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT pinacate EVACUATE FROM AREA OF IMPENDING DANGER operation to be conducted, then complete Section VI or Vill as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTiON FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS C 6 MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE
NAME ADDRESS Joe Quality 420 W Jackson, Unionville, MO 65265 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION BA AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and SIS (Check applicable blocks and complete items as indicated) AIRWORTHINESS DIRECTIVES (Check if all applicabie ADs are compiled with and give the number Reviskon No/ F2245-09 2010-08, NONE SUPPLEMENT available in the biweekly series as of the date of application AIRCRAFT LISTING (Give page number (s)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STO Incorporated)
N/A N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 25 Terences 14 CFR section 91.417 D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in ccordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for th airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 04/15/2010 Joe Quality, Owner Jar Quality A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183Y0) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GNe CERTIFICATED MECHANIC (Give Certiticate No.) CERTIFICATED REPAIR STATION (Give Certificate AGENCY AIRCRAFT MANUFACTURER (GIve name or fir Certificate No.)
DATE TITLE SIGNATURE (Check ALL applicable block Rems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE A. I find that the aircraft described in Section I or VIl meets requirements for B. Inspection for a special flight permit under Section VII AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE
CERTIFICATION FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-9
Appendix D Figure D-9. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Light-Sport Category Without Type-Certificated Installations (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE I, VI, and VIl as applicable Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO N118GX 6. ENGINE BULDER'S NAME (Make) Remos Aircraft GmbH 7. ENGINE MODEL DESIGNATION GX 2009 340 Rotax Aircraft Engines 9120L
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable 1 Neuform CR3-65 IMPORT APPLICATION IS HEREBY MADE FOR: (Cheek applicable items) A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) _ NORMAL UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate fems)
PRIMARY 9V LIGHT-SPORT (Indicate Class) / Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 12 AERIAL SURVEY 3 AERIAL ADVERTISING RESTRICTED (Indicate operations) FOREST (Wildlife conservation) PATROLLING WEATHER CONTROL OTHER (Specily) RESEARCH AND DEVELOPMENT 13 EURANE KET SURVEY EXHIBITION
AIR RACING TO SHOW COMPLIANCE WITH THE CFR 7 OPERATING (Primary Category) KIT BUILT AIRCRAFT EXPERIMENT AL (Indicate operations) to be conducted) OPERATINO 8A 8B Existing aircraft without an airworthiness certificate & do not meet § 103.1 Operating Light-Sport Kit-built _IGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthines certificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT (Indicate EVACUATE FROM AREA OF IMPENDING DANGER Section VI or Vil as appicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation? and "Standard" or Limited" as applicable) A REGISTERED OWNER (As shown on certificate of alcraft registration) IF DEALER, CHECK HERE NAME Remos Aircraft, Inc. 997 Happy Trails Dr, Ste D-1, Rogers, AR 72756 B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete xems as Indicatec) III. OWNER'S CERTIFICATION AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and AIRWORTHINESS DIRECTIVES (Check it all applicable ADs are complied with and give the number Revision No/ F2245-07 a 2009-21, SD-001, SD-002, SD-003, SD-004, SD-005 AIRCRAFT LISTING (Give page number(s) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated)
N/A N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 10 D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Awiation Administration in accordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 10/22/2009 Bill Brown, Agent Bill Braven A THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21,183Y%) applies) IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GIve CERTIFICATED MECHANIC (Give Certiticate No.) CERTIFICATED REPAIR STATION (GIve Certificate AGENCY AIRCRAFT MANUFACTURER (GIe name or fim) Certificate No.) No.)
DATE TITLE SIGNATURE (Check ALL applicable block items A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE A. I find that the aircrat described in Section I or VIl meets requirements for AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE B. Inspection for a special flight permit under Section VII CERTIFICATION was conducted by: FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-10
Appendix D Figure D-10. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Limited Category (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special fight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration
1. REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) , AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING I. AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO. N1256 6. ENGINE BUILDER'S NAME (Make) Glenn L. Martin Company 7. ENGINE MODEL DESIGNATION B-26C 1943 2256 P&W R-2800-83AMB
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check it applicable) Hamilton Standard 42E60-7/669-5-8 IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) STANDARD AIRWORTHINESS CERTIFICATE (indicate category) NORMAL UTILITY | TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items)
PRIMARY LIGHT-SPORT (radicade Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED
CLASS I PROVISIONAL (Indicate class)
CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING RESTRICTED (Indicate operation(s) to be conducted) FOREST (Micide conservation) 5 | PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT | 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indcate operation(s) to be conducted) OPERATING 8B Operating Light-Sport Kit-built LIGHT-SPORT 8C certificate under § 21.19 Operating light-sport previously issued special light-sport category airworthines UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING
AIRCRAFT MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT indicate EVACUATE FROM AREA OF IMPENDING DANGER Section Vi or VII as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Cheek ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE
NAME ADDRESS Gas Transmission Company 1216W 48th Street, Dallas TX 64072 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION BASIS (Check ap AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and eks and complete Rems as indicated) AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number Revision No./ AL-33 Rev 1 of the last AD SUPPLEMENT avallable in the bleekly series as of the date of application 2010-02 AIRCRAFT LISTING (Ge page number(5)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A
AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours fiown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 12632 or renewed D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seg, and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for thi airworthiness certificate requested DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 01/27/2010 George Brown, President Gearge Braven A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183(d) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER /Give CERTIFICATED MECHANIC (Give Certificate No.) CE) TIFICATED REPAIR STATION (Gre Corticate Certificate No.)
AIRCRAFT MANUFACTURER (Give name or firm)
SIGNATURE (Check ALL applicable block items A and B THE CERTIFICATE REQUESTED A. I find that the aircraft described in Section I or VII meets requirements for AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE B. Inspection for a special flight permit under Section VII was conducted by: FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO AA INSPECTOR'S SIGNATURE or DESIGNEE* FAA INSPECTOR'S CERTIFICATION FILE REVIEV
OFFICE SIGNATURE AND NI SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-11
Appendix D Figure D-11. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Provisional Category (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special fight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VII as applicable.
Administration , REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) , AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING I. AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO. N502A 6. ENGINE BUILDER'S NAME (Make) Lock heed -Georgia Co. 7. ENGINE MODEL DESIGNATION 382G 1996 4387 Allison 501-D22A
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable) 4 Hamilton- Standard 54H60-91/54H 60-117 IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) STANDARD AIRWORTHINESS CERTIFICATE (indicate category) NORMAL UTILITY | TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items)
PRIMARY LIGHT-SPORT (radicade Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED PROVISIONAL (Indicate class) 1 / CLASS I
CLASS II II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING RESTRICTED (Indicate operation(s) to be conducted) FOREST (Micide conservation) 5 | PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT | 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR OPERATING (Primary Category) KIT BUILT AIRCRAFT 8A • Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indcate operation(s) to be conducted) OPERATING 8B Operating Light-Sport Kit-built LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthines certificate under § 21.19 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING
AIRCRAFT MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT indicate EVACUATE FROM AREA OF IMPENDING DANGER Section Vi or VIl as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Cheek ABOVE "Restricted Operation? and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on cert/ficate of aircraft registration) IF DEALER, CHECK HERE →
NAME ADDRESS Lockheed Georgia Co. Marietta, GA 30060 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION BASIS / Revision No.) A1S0 AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and and complete Rems as indicated). AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number of the last AD SUPPLEMENT avallable in the bleekly series as of the date of application 2010-07 AIRCRAFT LISTING (Ge page r SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated) N/A
AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours fiown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 12632 or renewed D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seg and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 04/10/2010 George Brown, President Gearge Braven A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only If 14 CFR part 21183(0) apples) IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER /Give CERTIFICATED MECHANIC (Give Certificate No.) CE) TIFICATED REPAIR STATION (Gre Corticate Certificate No.)
AIRCRAFT MANUFACTURER (Give name or firm)
SIGNATURE (Check ALL applicable block items A and B THE CERTIFICATE REQUESTED A. I find that the aircraft described in Section I or VII meets requirements for AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE B. Inspection for a special flight permit under Section VII was conducted by: FAA INSPECTOR FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO AA INSPECTOR'S SIGNATURE or DESIGNEE* FAA INSPECTOR'S CERTIFICATION FILE REVIEV
OFFICE SIGNATURE AND NI SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-12
Appendix D Figure D-12. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Restricted Category (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional pace is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE 1, VI, and VII as applicable Administration REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING I. AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO. N7777 North American Rockwell 6. ENGINE BUILDER'S NAME (Make) 7. ENGINE MODEL DESIGNATION S2R 1950 1916R P&W R1340AN1(S 3H1)
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable) Hamilton Standard 12D40-305/EAC/AG 100-2 IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) NORMAL • UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate ters)
PRIMARY LIGHT-SPORT (nascate Class) Airplane Pover-Parachute Weight-Shif-Control T Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I
CLASS II II. CERTIFICATION REQUESTED / AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING RESTRICTED (Indicate operations) to be conducted) FOREST (Wildlife conservation) PATROLLING WEATHER CONTROL OTHER (Specity) RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR OPERATING (Primary Category) KIT BUILT AIRCRAFT SA Existing aircraft without an airworthiness certificate & do not meet § 103.1 EXPERIMENTAL (Indcate operation(s) to be conducted) OPERATING 8B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthines certificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT pinacate EVACUATE FROM AREA OF IMPENDING DANGER Section VI or VII as applicable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 15 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE•
NAME ADDRESS DBA Crop Dusters, Inc. 105 Airport Rd., Greenville, MI 38701 B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete tems as indicated) III. OWNER'S CERTIFICATION AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and Revision No) A4SW Rev 5 2010-07 AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number last AD SUPPLEMENT available in the biweekly series as of the date of application AIRCRAFT LISTING (Give page number(s)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC Incorporated) C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 2105 D. CERTIFICATION - T hereby certify that I am the registered owner (or his agent) of the aircraft deserbed above, that the aircraft is registered with the Federal Aviation Administration in coordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for th airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 04/10/2010 John J. Jones, Co-Owner Jaken J. Ganes A THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.1830) apples IV. INSPECTION VERIFICATION 14 CFR part 121 CERTIFICATE HOLDER (GNe CERTIFICATED MECHANIC (Give Certificate No.) CERTIFICATED REPAIR STATION (Give Certificate AGENCY Certificate No) AIRCRAFT MANUFACTURER (GIve name or tim
DATE TITLE SIGNATURE (Check ALL applicable block tems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE CERTIFICATION B. Inspection for a special flight permit under Section VII A. I find that the aircraft described in Section I or VIl meets requirements for was conducted by: FAA INSPECTOR AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEV OFFICE SIGNATURE AND NO. SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-13
Appendix D Figure D-13. Sample FAA Form 8130-6, Application for U.S. Airworthiness Certificate, Special - Experimental Category, Research and Development (Face Side Only) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE Form Approved O.M.B. No. 2120-0018 APPLICATION FOR INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA U.S. Department of Transportation U.S. AIRWORTHINESS use only. Submit original only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections Federal Aviation CERTIFICATE II, VI, and VIl as applicable.
Administration
1. REGISTRATION MARK 2. AIRCRAFT BUILDER'S NAME (Make) AIRCRAFT MODEL DESIGNATION 4. YR. MFR FAA CODING AIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO. N51CA 6. ENGINE BUILDER'S NAME (Make) Cessna Aircraft Company 551 7. ENGINE MODEL DESIGNATION 1992 551-0004 JACL JT15D-4
8. NUMBER OF ENGINES 9. PROPELLER BUILDER'S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT IS (Check if applicable) 2 N/A N/A IMPORT APPLICATION IS HEREBY MADE FOR: (Check applicable items) | STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) NORMAL UTILITY ACROBATIC BALLOON OTHER SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate Rems)
PRIMARY LIGHT-SPORT (nacate Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
LIMITED PROVISIONAL (indicate class) CLASS I CLASS I| II. CERTIFICATION REQUESTED AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY AERIAL ADVERTISING RESTRICTED (Indicate operations) to be conducted) FOREST (Wildlife conservation) PATROLLING WEATHER CONTROL OTHER (Specity) / RESEARCH AND DEVELOPMENT •AMATEUR BUILT EXHIBITION AIR RACING CREW TRAINING 6 MARKET SURVEY TO SHOW COMPLIANCE WITH THE CFR OPERATING (Primary Category) KIT BUILT AIRCRAFT < EXPERIMENTAL (Indicate operation(s) SA Existing aircraft without an airworthiness certificate & do not meet § 103.1 OPERATING _ 8B Operating Light-Sport Kit-built
LIGHT-SPORT 8C Operating light-sport previously issued special light-sport category airworthiness certificate under § 21.190 UNMANNED 9A RESEARCH AND DEVELOPMENT 9C CREW TRAINING AIRCRAFT 9B MARKET SURVEY
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE SPECIAL FLIGHT PERMIT pracate EVACUATE FROM AREA OF IMPENDING DANGER 8 Section VI or VII as appleable on reverse side) OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS C 6 MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE "Restricted Operation and "Standard" or "Limited" as applicable) A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE•
NAME ADDRESS Cessna Aircraft Company 1 Airport Road, Wichita, KS 67277-7704 III. OWNER'S CERTIFICATION B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete tems as indicated) AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No and Revision No.) N/A AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number last AD SUPPLEMENT available in the biweekly series as of the date of application 2008-23 AIRCRAFT LISTING (Give page nu SUPPLEMENTAL TYPE CERTIFICATE (List number of each STO Incorporated)
N/A N/A C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS CHECK IF RECORDS IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate issued COMPLIANCE WITH 14 CFR section 91.417 2509 or renewed 22 D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seg. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE 11/15/2008 A.D. Smith, Director of Total Quality A.D. Smill A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21183(0) apples IV. INSPECTION AGENCY VERIFICATION Certificate No) AIRCRAFT MANUFACTURER (Give name or fim) 14 CFR part 121 CERTIFICATE HOLDER (GiVe CERTIFICATED MECHANIC (Give Certiticate No.) CERTIFICATED REPAIR STATION (GiVe Certicate
DATE TITLE SIGNATURE (Check ALL applicable block tems A and B) THE CERTIFICATE REQUESTED V. FAA REPRESENTATIVE CERTIFICATION B. Inspection for a special flight perit under Section VII A. I find that the aircraft described in Section I or VIl meets requirements for was conducted by: FAA INSPECTOR AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE FAA DESIGNEE CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145 DATE MIDO/FSDO FAA INSPECTOR'S SIGNATURE or DESIGNEE'S FAA INSPECTOR'S CERTIFICATION FILE REVIEW
OFFICE SIGNATURE AND NO SIGNATURE FAA Form 8130-6 (04-11) All Previous Editions Superseded D-14