STC SA12CE

!.ij. ~\I.- '_.J , , -FORM "':n':'2U; ::KIXXXXl£XXlKmEKXIDe~:&~ Form Approved, Budget Bureau No. 4I-RI823

(7.56) c ~j!~~~~XMX~X .) FEDERAL AVIATION AGENCY INSTRUCTIONS- Submit in triplicate to local FAA FI ight Operations and Airworthiness 1n- SUPPLEMENTALTYPECERTIFICATE spector. Copy will be returned to applicant upon issuance.

1. NAME AND ADDRESS OF APPLICANT 2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOr.:

'.;• E. Avery .KJ.AI RCRAFT o ENGINE [J PROPELLER 116 Kuul.eiHoad ORIGINAL MODEL DESIGNATION Kailua, Hawaii Cessna 17'1 ('skvlark) ;175.A.;B.C NEW MODEL DESIGNATION (If desired) None

3. DESCRIPTION OF CHANGE Removal at'Righ.tcabin door.

Iust:al1 Placarc in full vi~ ••., of pilot:

"Yhen door it: rt".m::r:c:d:

Maxi.m:Jm airape-cd 123 ~ ~o ~l;inb i~ermltted N,-;)LDose Objects in Cahi,n Day O;>m:ation Only in Precipitation Free J.d.r" Data ltequired: Copy of eMs Supplemental Type C.e.:rtificate 4a. WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS' [X]YES o NO

b. WILL PARTS BE MANUFACTURED FOR SALE (Ref. CAR I.55)' DYES [iJ NO

5. SIGNATURE AND TITLE OF APPLICANT ~~W~t;:QjSI GNAT RE January :SO lC16r,; :~gent•• , c G

DATE OF APPLI CATION TITLE

6. TO BE COMPLETED BY FAA

NATURE AND LOCATION OF DATA Deac.rlpt1ve.. substanU.4ti.ni ,data and inspec tion r8?or t on f Ll.e in Federal Aviation Agency 6 It"l.i$ht St.lJ.n(iarea Division. E.ngiueerillg & Manufacturing ilraac.h, !{.a..n,£as City. i1i~$Ouri.

Approval. Basf.B : CAR 3 FAA ORIGINAL TYPE CERTIFICATE NO. ~A APP ROVAL .. .

3A17 0r)7;':1::"~'. >::-."7~,,:_ :...~~ Y!,,~r'o:.hc;J. O:Icc;~ SUPPLEMENTAL TYP E CERTI F I CATE NO.

SA12CE SIGNATURE Walter .J. O'Toole., Acting 1Jh1~f DATE OF APPROVAL Engineering ~ foI.anu£act:urlng r.~bFebruary25, 1~62 TITLE USCOMM-DC 32772 FORM ACA-~~17(7.S~)