0
Form Approved
MAJOR REPAIR AND ALTERATION
OMS No. 2120-0020
US Department
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
ofT ransportation
Federal Aviation
Office Identification
Administration
INSTRUCTIONS: Print or type all entries. See FAR 43.9, FAR 43 Appendix 8, 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 412
1. Aircraft
Serial No.
Nationality and Registration Mark
36106 USA N412SV
Name
(As shown on registration certificate) Address (As shown on registration certificate)
PO BOX 2190
2. Owner AIRCRAFT ASSOCIATES INC MANASSAS VA 20108-0826
3. For FAA Use Only
The data identified herein complies with applicable airworthiness requirements
aod is ap~~bject to a ooofonni(y iospecUon
ers oriz 1 43,MA'on
2
430
2008
/ Signpe ACE»80-19
Date
r
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. Agency's Name and Address
8. Kind of Agency C. Certificate No.
U.S. Certificated Mechanic
EDWARDS
& ASSOCIATES, 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 Authorized
lndivid~ .
5/22/2008
JEFFREY L..·.MULLIN /~;;,~~
7. Approval 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
~
APPROVED D REJECTED
FAA Flt. Standards
Inspector
Manufacturer Inspection Authorization
Other
(Specify)
BY
FAA Designee x Repair Station
Person Approved by
Transport Canada
Airworthiness Group
Date of Approval or Rejection
Certificate or
Signature of Authorized
lndivi~~e....._
Designation No.
5/22/2008
FKFR930D
JEFFREY L. MULLIN
FAA Form 337 (12-88)
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