RECEIVED MAY 1 9 199S
'~
Form Approved
MAJOR REPAIR AND ALTERATION
OMS No. 2120-0020
US Deparrmenr
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
orTronspor1011on
Offf-jJ~()fi:j~
~rel Aviation
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 not to exceed $1,000
for each such violation (Section 901 Federal Aviation Act of 1958).
I
Make
Model
BELL Ha..lCOPTER TEXTRON
412EP
1. Aircraft
Serial
No.
Nationality and Registration Mark
36106
N82628
Name (As shown on registration certificate)
Address (As shown on registration certificate)
TEXTRON FINANCIAL CORRORATON
9001 AIRPORT FWY STE 800
2. Owner
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) .,,, ••• ,, •••
xx
POWERPLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address
B. Kind of Agency
C. Certificate No.
HAS CORPORATION
U.S. Certificated Mechanic
PO BOX 1117
Foreign Certificated Mechanic
MOUNT PLEASANT PA 15666
VY
Certificated Repair Station
GS1R177K
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
QUENTIN A BAKER I INSPECTOR~ - ./
/,
17 MAY 99
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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
Kl APPROVED O REJECTED
FAA Flt. Standards
Manufacturer
Inspection Authorization
Other
(Specify)
Inspector
BY
FAA Des1gnee Repair Station
Person Approved by Transport
xx
Canada Airworthiness Group
Date of Approval or Rejection Certificate or
Signature of Authorized Individual
LA
~
Designation No.
INSPECTOR&_:..~ .:-y~
17 MAY 99
GS1R177K
QUENTIN
A BAKER/
FAA Form 337 ,,2.aa1
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