STC SH921NE

FAA Form 8110-2 (5/14) Page 1 of 2

Number: SH921NE

Part 29 of the Federal Aviation Regulations.

Original Product – Type Certificate Number: H10EU Make: Airbus Helicopters Model: SA365N1 and AS365N2 Description of Type Design Change:

Installation of an Emergency Medical Services Interior in accordance with Custom Aircraft Completions, Inc. Installation Drawing List Report No. 8209-365-400, dated November 11, 1991 and Advanced Flight Systems, Inc. Drawing List No. 8000172-100-00, dated November 11, 1991.

1. Custom Aircraft Completions, Inc. Rotorcraft Flight Manual Supplement for Aerospatiale SA365N1 and AS365N2 Helicopters, Document No. 8000209-RPT 1, no Revision, dated September 13, 1991, FAA approved December 13, 1991, is required with this installation.

2. Refilling oxygen bottles insitu is allowed with no occupants.

3. The installer must determine whether this design change is compatible with previously approved modifications. If the holder agrees to permit another person to use this certificate to alter a product, the holder must give the other person written evidence of that permission.

Date of Application: October 23, 1991 Date Reissued: May 5, 1992; February 10, 2017 Date of Issuance: December 13, 1991 Date Amended:

Signature

Title James A. Grigg Manager, Fort Worth Aircraft Certification Office, Southwest Region RSG Products 3900 Falcon Way, Hangar 16S Fort Worth, TX 76106

FAA Form 8110-2 (5/14) Page 2 of 2

Transfer the ownership of Supplemental Type Certificate Number: SH921NE

To (Name and address of transferee)

From (Name and address of grantor)

United States of America Department of Transportation Federal Aviation Administration Supplemental Type Certificate (Continuation Sheet) Number: ST10962SC

FAA Form 8110-2 (5/14) Page 3 of 3