STC SA02203SE

Supplemental type certificate · Edward F. Forner

Holder
Edward F. Forner · United States
Status
Current · Issued
Status date
November 1, 2011
Applied
May 16, 2011
Product
Aircraft · Single-Engine
Certification basis
Part 3, Part 21
Data sheet
TCDS1A13

From FAA DRS, with our copy of the certificate PDF. DRS record last changed December 6, 2025.

What it approves

Installation of a Hartzell Propellers, Inc. model HC-C2YK-1BLF/FL7666A-4Q constant speed propeller in accordance with Installation Instructions Document No. 012-010 dated September 20, 2011.

What the certificate says

From the PDF’s text layer, without the form’s printed wording. Layout and order may differ; the PDF is the record.

United States of America Department of Transportation_Federal Aviation Administration Supplemental Type Certificate Number SA02203SE

This certificate, issued to: Edward F. Forner 5510 Sleater Kinney Rd. NE Olympia, WA 98506

Part 3 of the Civil Air Regulations.

Original ProductType Certificate Number: 1A13 Make: Revco, Inc.

Model: Lake LA-4 S/N 345

Description of the Type Design Change: Installation of a Hartzell Propellers, Inc. model HC- C2YK-1BLF/FL7666A-4Q constant speed propeller in accordance with Installation Instructions Document No. 012-010 dated September 20, 2011.

Limitations and Conditions: Data pertaining to this modification are considered inadequate for duplication in other aircraft. This approval is limited to the installation in Revco, Inc. model LA-4 aircraft, Registration N2012L, Serial Number 345 only. A copy of this Certificate and the Instructions for Continued Airworthiness Document No, 012-011 dated October 18, 2011 must be maintained as part of the permanent records for the modified aircraft.

If the holder agrees to permit another person to use this certificate to alter the product, the holder shall give the other person written evidence of that permission.

Date of application: May 16, 2011 Date reissued:

Date of issuance: November 1, 2011 Date amended:

FAA FORM 8110-2(10-68

(Signature) Acting Manager, Seattle Aircraft Certification Office (Title)

ADs that name this STC · 0

An AD can apply because an STC is installed, or mention one in its text.

No AD in this release names this STC

Approved models · 1

MakeModelData sheet
REVO IncorporatedLake LA-41A13