RECEIVED MAY 2 o 1997
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Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
US Deportment
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
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Office Identification
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Fed<tral Aviation
/Jz/1-r.s-JJ c:>-Jk;> 3
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
lE..IC<PTER
TEXTRON
412EP
1. Aircraft
Serial No.
Nationality and Registration Mark
36106 N82628
Name (As shown on registration certificate)
Address (As shown on registration certificate)
2.
Owner
1EXTRON FINANCIAL eoo?OOATION
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) •
.,..,. . ., ,. ....
#',#,#
·--
xx
POWERPLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address
B. Kind of Agency
C. Certificate No.
lE..IC<PTER AVIATION SERVICES CORP.
U.S. Certificated Mechanic
P.O. BOX 1117 MOUNT PLEASANT AIRPORT
Foreign Certificated Mechanic
GS1R177K
MOUNT
FLEASJ\NT, PA
15666
Ai',
Certificated Repair Station
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.
/l
Date
Slgoatun> of Authori,ed todi,idu;Jg
-11:-tta
15 MAY 97
Al.LEN TUBBS I INSPECTOR ,
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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
ij() APPROVED O REJECTED
FAA Flt. Standards
Manufacturer
Inspection Authorization
Other
(Specify)
Inspector
BY
FAA Designee
xx Repair Station
Person Approved by Transport
Canada Airworthiness Group
Date of Approval or Rejection Certificate or
Slgoatun, of Authori,ed lodi,idua';J ,U,,_
15 MAY 97
Designation. No.
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GS1R177K
Al.LEN TUBBS I INSPECTOR .,, .,
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FAA Form 337 c12-aa1
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