0
Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
US Department
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Orply\ \.
ofT ransportation
Federal Aviation
Office ldentifica15n l~rv
Administration
SO-FSD -03 ·
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 I Section 901 of Federal Aviation Act of 1958).
Make
Model
BELL HELICOPTER TEXTRON 412EP
1. Aircraft Serial No. Nationality and Registration Mark
36106 USA N26NY
Name (As shown on registration cerlificate) Address (As shown on registration cerlificate)
2. Owner UNITED AIR SURVEYS INC
P.
0. BOX 1195
LAKEHURST, NJ 08733-0695
3. For FAA Use Onlv
4. Unit Identification 5. Type
Unit Make
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 Aoencv C. Certificate No.
U.S. Certificated Mechanic
EDWARDS & ASSOCIATES, INC
Foreign Certificated Mechanic
PO BOX3689 x
Certified Repair Station
FKFR930D
BRISTOL TN 37625
Manufacturer
D.
I certify that the repair and/or alteration made to the unit(s)
ic:ientified 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 lndiv~
5/29/03
JEFFREY MCKAMEY
_ // -~ ./.
--A
7. Annroval for Return To Service //
,,, //-
/
-
/7
Pursuant to the authority given persons specified below, the unit identified in item 4 was inspected in the manner pres~ by the
Administrator of the Federal Aviation Administration and is ® APPROVED o 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 Individual
~&'- /-
Designation No.
JEFFREYMCKAMEY /2/£,
5/29/03
FKFR930D
"'7
/
FAA Form 337 (12-88)
71n~ /
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