STC SA526SW

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FEDERAL AVIATION AGENCY

1. NAME AND ADDRESS OF APPLICANT Mitchell Industrie*, Inc.

Municipal Airport P. 0. Box 610 Mineral Well*, Texas 76067

3. DESCRIPTION OF CHANGE Installation of Mitchell Automatic Trim Industrie* , Inc. Bulletin Ho. 284 dated bulletin* and/or supplements (ILL DATA BE AVAILABLE FOR SALE OR RELEASE TO

b. WILL PARTS BE MANUFACTURED FOR SALE (Ret. CAg

5. SIGNATURE AND TITLE OF APPLICANT June 15, 1965

DATE OF APPLICATION 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

2. SUPPLEMENTAL TYPE CERTIFICATE APPLIED FOR:

I xl AIRCRAFT I I ENGINE I, J PROPELLER

ORIGINAL MODEL DESIGNATION Cessna 210-5, 210-5A, 206, P206, & 0206 NEW MODEL DESIGNATION (If demired) none Model AK171 in accordance with Mitchell 6/16/65 and subsequent FAA approved OTHER PERSONS? Ik 1 YES 1 1 NO

1.55)7 l*~l YES 1 1 NO

SIGNATURE f reject Engineer TITLE

6. To be Completed by FM

NATURE AND LOCATION OF DATA Data listed in Item 3 above, and T1R A726SWS on file at Stt-210.

Applicable regulations: same as original certification.

Reference Project A726SWS ORIGINAL TYPE CERTIFICATE NO. FAA AP 3A21 andA4CE SUPPLEMENTAL TYPE CERTIFICATE NO. ^ SA526SW DATE OF APPROVAL H. ] 6/18/65 Chil =ROVAI_ «fe^L SI GNATURE I. slaughter if Engineering and Manufacturing Branch Tl TLE * U.S. GOVERNMENT PRINTING OFFICE : 1959 O—509657 FORM FAA-2417 (5-59)