0
'
Form Approved
,.
MAJOR REPAIR AND ALTERATION
OMS No. 2120-0020
us Department
of Transportation
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
Federal Aviation
Office !e;!~rfsbo-03
Administration
INSTRUCTIONS: Print or
type all entries. See FAR 43.9, FAR 43 Appendix B, and AC 43.9-1 (or subsequent re~ilm tflereof) 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 iSection 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 certificate)
Address (As shown on registration cerliflC8fe}
TEXTRON FINANCIAL CORP.
9001 AIRPORT FWY. Suite 800
2.0wner
FORT WORTH TX 76180
3. For FAA Use Onlv
The data identified herein compli9t_ with applicable airworthiness requirements
am! • -;m_~·-' a;,c,aft su~ect to a conf"'m<y ITTSpection
b a~ e on a tin FAR 43, section 43.7
,. A.,{ - u- i'J- Jll-t> I
~signatuye ASO-Ff D0-03 Date
I
4. Unit
·-
jnn
5.TvnA
Unit Make Model Serial No. Repair
Alteration
AIRFRAME
(As described in Item 1 above)
x
POWERPLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Aaency's Name and Address
B. Kind
of Agency
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
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
/J_ /£/? __ .
12-27...;01
James J. R~.
7. Annroval for Return To Semce /
~/
/7
/
Pursuant to the authority given persons specified below, the unit identified in item 4 was'1nspected in the' mam1'iir p~ribed by the
Administrator of the Federal Aviation Administration and is 00 APPROVED D REJECTED
FAA Flt. Standards
Manufacturer Inspection Authorization
Other
(Specify)
Inspector
BY
FAA Designee Repair Station
Person Approved by
x
Transport Canada
Airworthiness Group
Date of Approval or Rejection Certificate or
Signature of Auth~~
12-27-01
Designation No.
James J. Ro ..-- ·,,-,. -
~
Au» -
FKFR930D
FAA Form 337 (12-88)
~
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