STC SA5164NM

FAA Form 8110-2 (8/13) Page 1

Part of the Federal A viation Regulations.

Original Product – Type Certificate Number: MDNH:

MRGHO:

Signature

Title

SA5164NM B/E Aerospace, Inc. - FSI 11404 Commando Road W, Suite C Everett, WA 98204 25 A1NM Boeing 767-300 Installation of a closet in accordance with Flight Structures, Inc. Master Drawing List 91FS019-D01, Revision B, dated May 17, 1991 or later FAA approved revision.

Approval of this change in type design applies basically to the above model aircraft only. This approval should not be extended to other aircraft of this model on which other previously approved modifications are incorporated unless it is determined that the interrelationship between this change and any of those other previously approved modifications will introduce no adverse effect upon the airworthiness of that aircraft. A copy of this certificate and Flight Structures, Inc. Master Drawing List 91FS019-D01 must be maintained as part of the permanent records for the modified aircraft.

(See Continuation Sheets Pages 3 through 3) 3/18/1991 6/5/1991 6/12/1991, 4/21/2016 Lead Administrator ODA-635712-NM

FAA Form 8110-2 (8/13) Page 2

To (Name and address of transferee) From (Name and address of grantor) Extent of Authority (if licensing agreement):

SA5164NM

FAA Form 8110-2 (8/13) Page 3

SA5164NM Certification Basis:

The certification basis for this modification is in accordance with Type Certificate Data Sheet, A1NM.

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