STC SA363SW

FEDERAL AVIATION AGENCY

SUPPLEMENTAL TYPE CERTIFICATE 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

ISSUANCE

1. NAME AND ADDRESS OF APPLICANT Mitchell Industries, Inc.

Municipal Airport P.O. Box 610 Mineral Wells. Texas

2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOR:

AlRCRAFT ENGINE PROPELLER

ORIGINAL MODEL DESIGNATION Pip PA-23-23 5>•*> PA.21. PA.21.l4O. PA.21.2Sfl.

NEW MODEL DESIGNATION (If demired) NoneDESCRIPTION OF CHANGE *.„ Installation of Mitchell Pitch Trim System Model AK128 in accordance with Mitchell Industries. Inc. Bulletin No. 218 dated 5-13-64 and subsequent F. A. A.

approved Bulletins and/or supplements. Installation of Mitchell Pitch Trim System Model AK128R in accordance with Mitchell Industries. Inc. Bulletin No.

243 dated July 24, 1964.

II. Installation of Piper Altie*tic II Autopilot Model AJB090 in accordance with Mitchell Industrie*, lac. Bulletin He. 220 dated 3-12-64 and subsequent FAA approved Bulletins and/or Supeleaanta.

: Mitchell Industries, Inc. FAA approved placard 13*96 required.

WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS?

b. WILL PARTS BE MANUFACTURED FOR SALE (Kef. CAR 1.55)1 YES YES ONO d! NO

5. SIGNATURE AND TITLE OF APPLICANT Rev. 7*24-64 11-4-63

DATE OF APPLICATION

SIGNATURE Vice President TITLE

6. To fee Completed by FAA

NATURE AND LOCATION OF DATA Data listed ia Iteai 3 *bova and TIE A5278W8 en file at 8W-210.

Applicable CAft|s saw as original certification.

ORIGINAL TYPE CERTIFICATE NO.

IA10 SUPPLEMENTAL TYPE CERTIFICATE NO.

SA363SW

DATE OF APPROVAL 5-22-64 iavUed: 8*31*64

FAA APPROVAL

SIGNATURE B. Slaughter Chief, Engineering and Manufacturing Branch Tl TLE * U.S. GOVERNMENT PRINTING OfFICE : 1959 0—509657 FORM FA A-2417 (5-59)