STC SA3-640

FEDERAL AVIATION AGENCY Supplemental Type Certificate

1. NAME AND ADDRESS OF APPLICANT

ORVILLE CROWDER 3002 HENRY ST.

FLINT 6, MICHIGAN FORM APPROVED, BUDGET BUREAU NO. 04-R015

INSTRUCTIONS - SUBMIT IN TRI PLICATE TO LOCAL

FAA FLIGHT STANDARDS INSPECTOR,

COPY WILL BE RETURNED TO APPLICANT UPON Supplemental Type Certificate N3628VAN erial 3195 ICATE APPLIED FOR:

AIRCRAFT ENGINE PROPELLER

ORIGINAL MODEL DESIGNATION TAYLORCRAFT BL12-65 NEW MODEL DESIGNATION (If desired)

3. DESCRIPTION OF CHANGE CONLING MODIFIED TO ACCOMADATE SAHAUST STACKS. MOUNT, BAFFLES, AND CHAMLION TAC EXHAUST SYSTEM, EXHAUST SYSTEM. BAMOYST SYSOMING INSINEL E CONTINENTAL A 65-8 MOTOR MOUNT BAFFLES, MOTOR ENGINE, ENCINE ANI APPLYING FOR A "ONE AIRFLANE ONLY" APPROVAL.

4a. WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS? YES NO

b. WILL PARTS BE MANUFACTURED FOR SALE (Ref. CAR 1.55)? YES NO

5. SIGNATURE AND TITLE OF APPLICANT rikelate Unille Cinda HILIS TRES ASE 1202534 SIGNATURE ORVILLE CRO DER OWNER

A DATE O OF APFLICATION TITLE

6. To be Completed by FAA

NATURE AND LOCATION OF DATA Mr. Crowder's letters dated March 31, 1961, and April 28, ( Univair letters dated February 21, 1961, and March 3, 1961, and ground inspection report filed FAA Region 3, Engineering and Manufacturing Branch, Kansas City, Missouri.

Basis for Approval: CAR 4a.

Approved for one airplane only per Iten.2, above.

ORIGINAL TYPE CERTIFICATE NO. FAA APPROVAL 700 ORIGINAL SIGNED BY Supplemental Type Certificate NO. JOHN A. CARRAN John A. Carran SIGNATURE SA3-640

DATE OF APPROVAL Chief, Engineering and Manufacturing Branch May 9, 1961 TITLE MENT PRINTING OFFICE: 1959 0-509657 FORM FAA -2417 (5-59)