STC SA36SW

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 2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOR:

K I AIRCRAFT II ENGINE PROPELLER

ORIGINAL MODEL DESIGNATION NEW MODEL DESIGNATION (It demired)

3. DESCRIPTION OF CHANGE S/1»/6I with Vit/*t, t fhft* ft» * •trvttvv*!

in Miti-iiPM wttb toavlag ••* 100 6/14/62, MA lo«t«U»rt««t X»*tructiMa Bo. 101 £ot of fmet 1-1340 WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS?

b. WILL PARTS BE MANUFACTURED FOR SALE (Ret. CAR 1.55)1 1 1 YES HH NO [ITI YES [~~1 NO

5. SIGNATURE AND TITLE OF APPLICANT until it, it*a SIGNATURE

DATE OF APPLICATION TITLE

6. To be Completed by FAA

NATURE AND LOCATION OF DATA

•tt* li»M* ill ttM 3 *« fiU at W-no.

yORIGINAL TYPE CERTIFICATE NO.

IPPLEMENTAL TYPE CERTIFICATE NO.

DATE OF APPROVAL 7/U/61

FAA APPROVAL jJ^L llOTghftT

SIGNATURE Tl TLE * U.S. GOVERNMENT PBINTING OFFICE : 1959 O—509657 FORM FAA-2417 (5-59)