0
Form Approved
MAJOR REPAIR AND ALTERATION
OMB 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 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 $1,000
for each violation (Section 901 of Federal Aviation Act of 1958).
Make Model
BELL HELICOPTER TEXTRON
412EP
1. Aircraft Serial No. Nationality and Registration Mark
:
36106 USA N412SV
Name
(As shown on registration certificate)
Address (As shown on registration certificate)
AIRCRAFT ASSOCIATES INC. PO BOX 2190
2. Owner MANASSAS VA 20108-0826
3. For FAA Use
.Only
The data ;deaUfied hece;, compHe,:~f i'" a;,worth;aess raq,;cemeats
aad ;,
approved foe the
a~~
aicra '"bject to a amfom,;ty ;a,pect;o,
~
o · et R~. ~e~t~n ;3·; ZOO?
./ SiqJ;W!lfure p$,0'",,.FSD0-03 Date
/ / if
4. Unit Identification 5. Type
Unit
/Mak~
Model Serial No. Repair Alteration
AIRFRAME
----------- (As described in Item 1 above)---------- x
POWE RP LANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A.
Aqency's Name and Address B. Kind of Aqency
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.
/)
/J
-
Date
Sign~~f=zed lndividuUJ &
07 /18/2ffi7
7. Aooroval for Return To Service
'
I /
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
CE! APPROVED D REJECTED
FAA Flt. Standards
Manufacturer 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
s;goat,ce of A"1ho"2ed '"t:U
ol~J
07 /18/2ffi7
Designation No.
FKFR930D
1(M s. Al}m
FAA Form 337 (12-88)
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