STC SA378SW

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 V. L. Olaetaad Aerial Repairing P. 0. Box 909 Ponca City, Oklahoma

2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOR:

I——I AlRCRAFT ENGINE PROPELLER

ORIGINAL MODEL DESIGNATION PA«ia anA PA-1A NEW MODEL DESIGNATION (If demired) ————————none————————3. DESCRIPTION OF CHANGE Installation of LyeoAing 0*320 engine per Installation Instructions and parts List dated 1/16/63 and drawings listed thereon. Installation of 6 inch wheel* per Drawing WM-100 dated 1/16/64. Installation of Piper PA-18 horizontal tail surfaces per Installation Instructions dated 1/16/64.

MOTES: 1. FAA approved Airplane Flight Manual Supplement dated 4/28/64 required for the Piper PA-14 aircraft.

2. FAA Approved Airplane Flight Manual Supplement dated 10/28/65 required for the Piper PA-12 aircraft.

. WILL DATA BE AVAILABLE FOR SALE OR RELEASE TO OTHER PERSONS? £] YES CD NO

b. WILL PARTS BE MANUFACTURED FOR SALE (Kef. CAR 1.55)1 StU YES I1 NO

5. SIGNATURE AND TITLE OF APPLICANT

SIGNATURE

DATE OF APPLICATION TITLE

6. To be Completed by FAA

NATURE AND LOCATION OF DATA Data listed in Item 3 above and Conformity Inspection Reports dated 5/7/64 and 1/22/65 on file at 3W-210.

Reference Project: A2413WS Applicable regulations: same as original certification.

ORIGINAL TYPE CERTIFICATE NO.

780 6 797 SUPPLEMENTAL TYPE CERTIFICATE NO.

SA378SW

DATE OF APPROVAL 5/7/64 Revision 1 11/1/65

FAA APPROVAL

SIGNATURE H. H. Slaughter Chief, Engineering and Manufacturing BranchTl TLE * U.S. GOVERNMENT PRINTING OFFICE : 1959 0—509657 FORM FAA-2417 (5-59)