,,
OMB No. 2120-0020 I Electronic Tracking Number
Exp: 8/3112014
US Department
MAJOR REPAIR AND ALTERATION
For FAA Use Only
of Transportation
(Airframe, Powerplant, Propeller, or Appliance)
Federal Aviation
Administration
INSTRUCTIONS: Print or type all entries. See Title 14 CFR §43.9, Part 43 Appendix B, and AC 43.9-1 (or subsequent revision thereof) for
instructions and disposition of this· form. This report is required by law (49 U.S.C. §44701). Failure to report can result in a civil penalty for each
such violation. (49 U.S.C. §46301 (a))
Nationality and Registration Mark
Serial No.
36106
USA N223JC
1. Aircraft
Make
Model
I Series
Bell Helicopter Textron Canada Ltd.
412EP
Name (As shown on registration certificate) Address (As shown on registration certificate)
Aircraft Associates Inc.
Address PO Box 2190
2. Owner
City Manassas State VA
Zip 20108-0826
Country
USA
3. For FAA Use Onlv
-
4. Type
5. Unit Identification
Repair Alteration Unit Make Model Serial No.
D 0
AIRFRAME
(As described in Item 1 above)
D D
POWERPLANT
D
D
PROPELLER
Type
D
D
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address B. Kind of Agency
Name Aircraft Associates Inc.
x
U. S. Certificated Mechanic
I Manufact,uer
Address
10678Avtatlon Ln
Foreign Certificated Mechanic
C. Certificate No.
City
Manassas
State
VA
Certificated Repair Station
3393868
Zip
20110-2700
Country
USA
Certificated Maintenance Organization
D.
I certify that the repair and/or alteration made to the unit(s) identified in item 5 above and described on the reverse or attachments hereto
have been made in accordance with the requirements of Part 43 of the U.S. Federal Aviation Regulations and that the information
furnished herein is true and correct to the best of my knowledge.
Extended range fuel
s;gaaMelD•~ jJ h-,,
per 14 CFR Part 43
0
.3/z7/1s-
App. B
7. Aocroval for Return
tlrService
Pursuant to the authority given persons specified below, the unit identified in item 5
was inspected in the manner prescribed
by the
Administrator of the Federal Aviation Administration and is
nApproved
nRejected
FAA Flt. Standards
Manufacturer
Maintenance Organization
I Persons Approved by Canadian
Inspector
Department of Transport
BY
x
Other (Specify)
FAA Designee
Repair Station
Inspection Authorization
Certificate or
s;ga,Wz/z;j
Designation No.
3 I ()1 /,s
3L/b ll lfo
.
0
FAA Form 337 {10/06)
IPage I
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