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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
ld~Qtific~o,n;,~(: .,, ,
Administration
12l1Ll
1
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t 3~.'-'.0,:
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 N82628
Name
(As shown on registratton certifiC8le) Address (As shown on registration certif1CBte)
TEXTRON FINANCIAL CORP. 9001 AIRPORT FWY. Suite 800
2. Owner
FORT WORTH TX 76180
3. For FAA Use On v
The data """1ified he,eln ~;cable ai"""'1hiness ,equ<emenls
and• aw~e.desorib c aft subject to a confonnity ns-on
.
by a ~~ut · in R 43, section 43. 7
. - ,.; - - /2- /fol- t!!/
/Signatr ASO-FF03
Date
4. Unit
ltf .. ntifi,.,.•ion 6. Tvne
Unit
Make
Model Serial No. Repair Alteration
AIRFRAME
(As described in Item 1 above)
x
POWERPLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A Ai:iencv'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 Auth7~·::7
~AJ~~
12-27-01
James J. R we _,., -
7. Annroval for Return To Sennce /
(.._..--' /
// /
Pursuant to the authority given persons specified below, the unit identified in item 4 ~~nspected in the man
Administrator of the Federal Aviation Administration and is
IEl APPROVED O REJECTED
r
pr,_tribed by the
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 Authoriz~
12-27-01
Designation No.
~~~-
FKFR930D
James J. Row ./ · '....-c-
FAA Form 337 (12-88)
/
._.///
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