Textron Cessna 172R - Page 197

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MAJOR
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AMD
ALTERATION
(Airframo,
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Propaiter,
or
Appliance)
Form
Approved
OMB
No
2120-0020
For
FAA
U»»
Only
Office
Identification
IHSTRUCÿNS:
for
eachsuch
violation
(Section
901
Federal
Avlatton
Act
of
1958ÿ
-
---
-
-
-
-
-
--
■'
Model
1
1.
Aircraft
2.
Owner
Make
CESSNA
Serial
No.
17281021
__
_
Name
(As
shown
on
registration
certifies
to)
FLIGHT
MANAGEMENT,
LLC
172R
_
Nationality
and
Registration
Mark
USA
N24730
3.
For
FAA
U—
Only
Address
(As
shown
on
registration
certificate)
891
BRIDGETON
LANE
PERRYSBURG
OH
43551
I
APPLIANCE
Unit
Mako
T
4.
Unit
Identification
Model
Scrtal
No.
»•
Typ°
—
Repair
Alteration
1
I
AIRFRAME
_____
_
(A,
/inscribed
In
Item
1
above)
-
(
V.
---- -
—
XX
I
POWERPLANT
I
PROPELLER
—
Typo
A.
Agency's
Name
and
Address,
XX
U
S
CartWoted
Mechanic!
_
Foretan
CwtWoatod
l*och«ajc_
Ccrtfflcated
Repair
Stattorÿ
XXER854K
RADIO
CLASS
1,11,111
iTniNSTR.Sÿ
EXPRESS
AVIONICS,
INC
11431
W.
AIRPORT
SERVICE
RD.
rT»—
SWANTON,
OHIO
43558
-
-
--
1
-
-
„,vi
doscrttxd
onttw
rover*
or
atuclrmate
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D.
.
certify
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S.
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Date
DECEMBER
19,
2001
THOMAS
A.
CORWIN
7.
Approval
for
Return
To
Seivtcc
__
&
rsuar
Tjlnla
it
tD
tne
aumoiuy
g
jntor
of
the
Fedora
FAA
Fit.
Standards
Inspector
1
Avl,
jttan
Administration
Manufacturer
and
%
8
APPROVED
U
KCJ
Inspection
Authorization
FAA
Designee
-
XX
Repair
Station
person
Approved
by
Transport
Canada
Alrworthlnoss
Group
Signature
of
Authorized
Individ
Other
(Spoctry)
DECEMBER
19,
2001.
FAA
Form
XVT
/19JVH
Designation
No.
XXER854K
THOMAS
A.
CORWIN.
MODEL
172R
SECTION
6
WEIGHT
&
BALANCE
/
EQUIPMENT
LIST
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