O~·
Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
• ·us· Department
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
ofTrmsportalion
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Offi~~~~on
Federal Aviation
. Administration
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INSTRUCTIONS: Print or type all entries. See FAR 43:9, FAR 43 Appendix B, ·and AC ·43.9-1 (or subsequent reyision thereof)Tol"T~tructions ·
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 412
1. Aircraft
Serial No.
Nationality and Registration Mark
36106
USA N82628
Name
(As shown on registration certificate)
::;
Address (As shown on registration certificate)
TEXTRON FINANCIAL co~~ORATION
9001 AIRPORT FWY STE 800
2. Owner
FORTWORTH TX 76180-7782
3. For
FM Use Only
'!ho data ldenlifled herein rjmplles wllb ,PPIJOftblO
MVJ!Ji~ui ~n Is approved for the abt)V§
ed 1rcr ,t ·ect f a conformity lnsp,)(;mm
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/4. Unit Identification
...........
f
5.Type
,
Unit
Make Model Serial No.
Repair Alteration
I
AIRFRAME
------- (As described in Item 1 above) -------
x
POWER PLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A Ai:1encv's Name and Address B. Kind of Ai:1encv
C. Certificate No.
U.S. Certificated Mechanic
EDWARDS
& ASSOCIATES , INC
Foreign Certificated Mechanic
PO BOX3689
x Certified Repair Station
FKFR930D
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
1/)
8/17/99
GARY D. DANIEL .&.ti.111 .~
7. Approval for Return To Service
{\
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
Clil APPROVED
O 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 Authorized Individual
.11.)
8/17/99
~~!fa~o.
GARY D. DANIEL ,k/'\
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A • , __
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-
FAA Form 337 (12-88)
6
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