0
Form Approved·
MAJOR REPAIR AND ALTERATION ..
OMS No: 2120-0020
us.Deporrmenr
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Onllf1)r'-"'
ot Tronsoorrooon
Office Identification
-
Federal Aviation
11.<::. O - J:=500
O">
Admlnlstratlan
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 such violation (Section 901 Federal Aviation Act of 1958).
Make
Model
,,.,
Bell Helicopter·Textron
..
412EP
1. Aircraft
Serial
No.
Nationality and Registration Mark
36106
USA N82628
Name (As shown on registration certificate)
Address ( As shown on registration certificate)
2. Owner
TEXTRON FINANCIAL CORP.
9001·Airport Fwy, Suite
800
Fort Worth,
TX 76180
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
POWER PLANT
·,
'
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address
8. Kind of Agency
C. Certificate No.
EDWARDS & ASSOCIATES, INC.
U.S. Certificated Mechanic
P.
o.
Box 3689
Foreign Certificated Mechanic
FKFR930D
Bristol,
TN
37625
x.
Certificated Repair Station
'LIMITED AIRFRAME
Manufacturer
RADIO
cl.Ass
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 Individual
12-27-01
James
J.
Row~
~~~JJ~
7. Approval for Return To Servi;_.e/' ~//.Y
/
Pursuant to the autho~ity given persons specified below, the unit identified in )furn .4 was inspec;e«n the/anner· prescribed by the
Administrator·of the Federal Aviation Administration and is
Q{ APPROVED' · O REJECTED · · ·
FAA Flt.
Standards
Manufacturer Inspection Authorization
Other
(Specify)
Inspector
BY
I FAA Designee
x
Repair Station
Person Approved
by Tra.nsport
Canada Airworthiness Group.
Date of Approval or Rejection
Certificate or Signature
of' Authorized Individual
Designation No.
Row62-
.~
~;-;--
12-27-01
FKFR930D James
J.
FAA Form 337 112-88/
/
/
//-
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