0
Form Approved
Electronic Tracking Number
OMB No. 2120-0020
MAJOR REPAIR AND AL TERA TION
2128/2011
US Department
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.
1. Aircraft
USA N223JC
36106
Make
Model
I Series
Bell Helicopter Textron Canada Ltd.
412EP
Name (As shown on registration certificate)
Address (As shown on registration certificate)
Address e Q Ball: 2190
2. Owner
City
Mi;!nas§i;!S
State V/}j
Aircraft Associates Inc.
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
Bell l:lelicaptec Ieitcao loc
eioe¥ Elats
U. S. Certificated Mechanic
I
Manufacturer
Address P. 0. Box 3689
Foreign Certificated Mechanic
C. Certificate No.
City
Bcistol
State I~
./
Certificated Repair Station
Zip
37625 Count,y USA
Certificated Maintenance Organization
FKFR930D
0.
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
Signature/Date of Authorized Individual
(
per 14 CFR Part 43
D
~
App. B
Jamie Norwood, January 29, 2013
-
~-
.
7. Aooroval for Return to S~ce
I
(
Pursuant to the authority given persons specified below,
the unit identified in~ was 'lr!s(ected in the manner prescribed
by the
Administrator of the Federal Aviation Administration and is
[]J Approved D Rejected
FAA Flt. Standards
Manufacturer
Maintenance Organization
Persons Approved by Canadian
Inspector
Department of Transport
BY
Other (Specify)
FAA Designee
./
Repair Station
ln_spection Authorization
.
Certificate or
Signature/Date of Authorized Individual
,
Designation No.
__/.
FKFR930D
Jamie Norwood, January 29, 2013
-
FAA Form 337 (10-06)
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