STC SA165SW

FEDERAL AVIATION AGENCY

SUPPLEMEKTAL TYPE CERTIFICATE FORM APPROVED, BUDGET BUREAU NO. 04-R015 INSTRUCTIONS - SUBMIT IN TRI R.ICATE TO LOCAL FAA FLIGHT STANDARDS INSPECTOR.

COPY WILL BE RETURNED TO APPLICANT UPON IS5UANC E

1. NAME AND ADDflESS OF APPLICANT Mitchell Industries Inc.

P. O. Box 6LO Municipal Airport Mineral Wells,

2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOR:

L-XJ AIRCRAFT \_ I ENGINE L 1 PROPELLER ORIGINAL MODEL DESIGNATION E35. F35. G35, H3 BEECH 35, 35R. A35, B35, C35, D35

NEW MODEL DESIGNATION (II NONE >. DESCRIPTION OF CHANGE Installation of Mitchell Automatic Pilot Model AK121 in accordance with Mitchell Industries Inc. Bulletin No. Z01 dated 11-15-62, and subsequent F. A. A, Approved Bulletins and/or Supplements.

NOTES: Mitchell Industries, Inc. FAA Approved Placard 13A89-100 required.

4*. WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS? [29 YES CD N0

b. WILL PARTS BE MANUFACTURED FOR SALE (Xef. CAS 1.3S)1 [__] YES C_] NO

5. SIGNATURE AND TITLE OF APPLICANT 11-15-6Z

DATE OF APPLICATION

SIGNATURE General Manager TITLE _.4_TgJ» Completed by FAA

NATURE AND LOCATION OF DATA Data listed in It*m 3 above on fiU at Stf-210.

Applicable CAR'a same aa original certification.

Kaf«r«nce Project A215SJS.

OHI6INAL TYPE CERTIFICATE NO.

777 and 3A15 SUPPLEMENTAL TYPE CERTIFICATE NO.

SA16SS-.J

DATE OF APPROVAL 12/3/62 FAA APPROVAL.

SISNATURE . H. Slaughter Chief, Engineering and Manufacturing Branch Tl TLE FORM FAA-2417 (3