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US
a Oepártrent
of fransportatim (Ai
MAJOR REPAIR AND ALTERATION
rframe, Powerplant, Propel !er, or Appl iance)
OMB No. 2120-0020
Ép 5R1,2018
Eléctrm¡c f mcking Numbér

For FAA Ur€ Only

F.drn¡ Aürtion i,
A.Írkútr.üon

INSTRUCTIONS: Print or type all entries. See Tritle 14 CFR §43.9, Part 43 Appendix B, and AC 43.$1 (or subsequent reúsion thereo$ for
instructions and d¡sposition of th¡s form. Th¡s report is required by law (49 U.S.C. §44701). Failure to report can result in a civil penalty for each
such violation. (49 U.S.C. §46301(a»
Nationality and Registration Mark serial No.

1. Ai¡craft
t,l ir-r*i .[i.¿ 5*o6
Mal(e Model Series
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Name (As shown on registration ce¡lifica@ Address (As shwn on rcgistntion catificate)
Addréss
2. üsner '',",\i'i i',
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j
C¡ty

zip Country

3. For FAA Use Onlv

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4. Type 5. Unit ldentif¡cat¡on

Repair Alteration Unit Make Model Serial No.

AIRFRAME (As described ¡n lten 1 above)

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n POWERPLANT I
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tr PROPELLER 1 ;:l

rype

APPLIANCE
Manufácturer

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A. Agency's Name and Address B. Kind ofAgency

Narc U. S. Certificated Mechan¡c Manufacturer
Address Foreign Certificated Mechanic C. Certificate No.
City §rgn LuTá -tolfrrs state 1!á¡ Ér¡\.¿ 'ld Certificated Repa¡r Station
zip
.J$<:ó co,ntry E. \ ae: \v<re,l,* Certificated Ma¡ntenance Organization s*rÁs¿>
D. I certiry that the repair and/or alteration made to the un¡t(s) identified in item 5 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 Regulat¡ons and that the ¡nformation
fum¡shed herein is true and correct to the best of my knowledge.

Extended range fuel Signature/Date of Authorized lndividual

',;
per 14 CFR Part 43
App.B tr h zq-$eb-zatt ;ti
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7. Approval for Retum to Service
Pursuant to the authority given persons spec¡fied below, the unit identified in item 5 was inspected in the manner prescribed by the
Administrator of the Federal Aviation Administration and is
f]Approved u
Rejected
FAA Flt. Standards Persons Approved by Canadian
Manufacturer Ma¡ntenance Organization
lnspector Department of Transport
BY
Other lspec/4/)

Certificate or
FAA Des¡gnee
X Repair Station lnspection Authorization

Signature/Date of Authorized lndividual

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Designation No.
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FAA Form 337 (L0/06)
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NOTICE
Weight be entered in the aircraft record. An alteration must be
conformity the

sheets. Identify with a'ircraft nationality and mark and date wo*
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Mark Date
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FAA Form 337 (10/05)

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