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~o
us Department
of T ransporlalion
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Federal Aviation
Administration
I
\, Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
Off~~~/)n ....
INSTRUCTIONS: Print or type all entries. See FAR 43.9, FAR 43 Appendix B, and AC 43.9-1 (or subsequent revision thereof) rar 111SlgJctions
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 $1,000
for each violation I Section 901 of Federal Aviation Act of 1958).
Make
Model
BELL HELICOPTER TEXTRON
412EP
1. Aircraft Serial No.
Nationality and Registration Mark
36106
USA N82628
Name
(As shown on registration certif/C8le)
Address (As shown on registration certificate)
TEXTRON FINANCIAL CORP.
9001 AIRPORT FWY. Suite 800
2.0wner
FORT WORTH TX 76180
3. For FAA Use Onlv
-
The dala --~es wfth applicable al,worthln,ss "'l••ements
and Is - "".'Z:'°" """° aWaft subject to a confonnlty Inspection
/fa rs tized in FAR 43, section 43.7
/l _·
~
ho. , 12, I I?-~ /
/$ign,ure A~FSD0-03
Date
I
4. Unit lmontifir.1ation 5.Tvne
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. Ai:iencv's Name and Address
B. Kind of Ai:iencv
C. Certificate No.
U.S. Certificated Mechanic
EDWARDS & ASSOCIATES , INC
Foreign Certificated Mechanic
FKFR930D
POBOX3689
x
Certified Repair Station LIMITED AIRFRAME
BRISTOL TN 37625
Manufacturer
RADIO CLASS I & II
0.
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
SignatureofAuth~~ A
12-27-01
James J. R e ./ -~ 'l,
7. Aooroval for Return To Service ./
<--/
~
/
Pursuant to the authority given persons specified below, the unit identified in item 4 wastlhspected in the mannefpres_s;ribed by the
Administrator of the Federal Aviation Administration and is
l&I APPROVED O REJECTED
FAA Flt. Standards
Manufacturer Inspection Authorization
Other (Specify)
Inspector
BY
FAA Oesignee Repair Station
Person Approved by
x
Transport Canada
Airworthiness Group
Date of Approval or Rejection
Certificate or
Signature of Auth~ ·~
Designation No.
James J. R e ./ /c..rv--:..-~ ~-----
12-27-01
FKFR930D
FAA Form 337 (12-88)
/
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