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Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
us
Deporrmenr
: (Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
ot Tronsponanon
Office Identification
Federal AYlatlon
<'o "--t:=-s.n11
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b3 Administration
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 notto 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 CORPORATION
9001 Airport
Fwy Ste 800
Fort Worth,
TX
76180-7782
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
B. Kind of Agency
C. Certificate No.
EDWARDS & ASSOCIATES, INC.
U.S. Certificated Mechanic
P.
o.
Box 3689
Foreign Certificated Mechanic
Bristol,
TN
37625
X•
'Certificated Repair Station FKFR930D
Manufacturer
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
5-16-2000
Ronnie L.
Kier
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7. Approval for Return To Service
......
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Pursuant to the authority given persons specified below, the unit identified in item 4 was inspected in the manner prescribed by the
Administrator of the Federal Aviation Administration and is
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APPROVED D REJECTED .
FAA Flt. Standards
Manufacturer Inspection Authorization
Other (Specify)
Inspector
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.
Q
~
5-16-2000
FKFR930D
Ronnie L. Kier
FAA Form 337 112-881
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