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 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
identified~~eapplicable airworthiness requirements
aod ;, ···7m-·"';be ;,craft '"bject to • co,fom,;ty ;ospect;o,
y r ~hori7L.~
~~R
4~trnr 23.8 2007
/ Signatu,€ A10~FSD0-03.,
Date
/
II I
4. Unit Identification 5. Type
Unit
Make
lG
Model Serial No.
Repair Alteration
AIRFRAME
----------- (As described in Item 1 above)----------
x
POWERPLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address
B. 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.
,,,,,-J
/J
-
-
Date
s;;:orizedlndividv y J 5£
7/18/2ffi7
7. Approval for Return To Service
y
l,
( )
Pursuant to the authority given persons specified below, the unit identified in item 4 was inspected in the manner
prescribeoby the
Administrator of the Federal Aviation Administration and is
IE! 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;goatuce of Authoriz~
dd/)2
7/18/2ffi7
Designation No.
FKFR930D
1CM s. AT..M\N
FAA Form 337 (12-88)
.,
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