0
Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
US Department
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
of Transportation
Federal Aviation
. Office Identification
Administration
INSTRUCTIONS: Print or type all entries. See FAR 43.9, FAR 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. 1421 ). Failure to report can result in a civil penalty not to exceed $1,000
for each violation (Section 901 of Federal Aviation Act of 1958).
Make Model
BELL HELICOPTER TEXTRON
412EP
1. Aircraft Serial No. Nationality and Registration Mark
36106
N223JC
Name
(As shown on registration certificate) Address (As shown on registration certificate)
AIRCRAFT ASSOCIATES INC
PO BOX 2190
2. Owner MANASSAS, VA 20108-0826
3. For FAA Use Only
4. Unit Identification
5. Type
Unit Make Model Serial No.
Repair Alteration
AIRFRAME
----------- (As described in Item 1 above) ----------
x
POWE RP LANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A.
Aoencv's Name and Address B. Kind of Agency C. Certificate No.
U.S. Certificated Mechanic
BELL
1-:!ELICOPTER TEXTRON INC
Foreign Certificated Mechanic
FKFR930D
PO BOX 3689
x
Certified Repair Station
LIMITED AIRFRAME
BRISTOL TN 37625
Manufacturer
RADIO CLASS I
& II
D.
I certify that the repair and/or alteration made to the unit(s) identified in item 4 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.
Date
Signature of
Author~di:id~
January 29, 2013
Bill Boatright
.J'.- - -
~
7. Aooroval for Return To Service
,
Pursuant to the authority given persons specified below, the unit identified in item 4 was inspected in the manner prescribed by the
Administrator of the Federal Aviation Administration and is
[8J APPROVED
D REJECTED
FAA Flt. Standards
Manufactu_rer Inspection Authorization
Other (Specify)
Inspector
BY
FAA Designee
x Repair Station
Person Approved by
Transport Canada
Airworthiness Group
Date of Approval or Rejection
Certificate or Signature of Authorized Individual
Designation No.
A~
.A7~7/---
January 29, 2013
FKFR930D Bill Boatright
FAA Form 337
(12-88)
.,
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