STC SA176SW

FORM ACA-2*17 U.S. DEPARTMENT OF COMMERCE

SUPPLEMENTAL TYPE CERTIFICATE Fora Approved, Budget Bateau No 41-K1823 INSTRUCTIONS - Submit in triplicate to local CAA Flight Operations and Airworthiness Inspector. Copy will be returned to applicant upon issuance.

1. NAME AND ADDRESS OF APPLICANT SHLRHAH V.

flQJ M. TCRRT STREET Font AWTH, TEXAS

2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOR:

|X | Al RCRAFT 1 ! ENGINE 1. 1 PROPELLER

ORIGINAL MODEL DESIGNATION f ;*Xie.Lt |w A., NOC^.!.

NEW MODEL DESIGNATION (11 desired)

3. DESCRIPTION OF CHANGE CH/WC.L CONTHOL SURFACE (ELEVATOR, RUDDERS AND AILERONS} COVERING PROM FAMIC TO ALUMINUM SHEET IN ACCOJIDMKC WITH ALRQNKTICS RC*O*T HO. t4j AND DWQ. <J-jOG POD SMgHMA* V. CORHSTuMte. THIS MODIFICATION is APPLICABLE TO THE KOLLOWING COMMERCIAL MODELS, 1HCLUOIM6 MILITARY MOOCL* UHCH CONVERTED TO O**t OF THESE DESICMAT tOttS:

MOOCL s-t3ft " - 757 7^5 lite, Bi8s elite oifls, oi6c» ti&s -. WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS' Cj YES

b. WILL PARTS BE MANUFACTURED FOR SALE (B«f. CAR J.J5J' CXl YES NO NO S. SIGNATURE AND TITLE OF APPLICANT

SIGNATURE

DATE OF APPLICATI ON

6. TO BE COMPLETED BY CAA

NATURE AND LOCATION OF DATA Beta list«4 111 Itcn 3 *bov* on flla «t SU-210.

•• original ft*f . ?roj«ct Appl Ic^lc CAB'a RI6INAL TYPE^ CERTIFICATE HO.

tt«« 3 SUPPLEMENTAL TYPE CERTIFICATE NO.

DATEOF*PPROVAL

CAA APPROVAL

SI GNATUBE B. H. Slaughter and Manufacturing Iranch Tl TLE USCOMM.DC 32772 FORM ACA-2417 (7-56)

-I trer O r * 1 ! F a; «.

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