EFTA00313129.pdf

FORM APPROVED OMB No. 21200042 UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION Malta Aviontet ADMINISTRATION-NIKE NONNIONEY AMONMOICAL C011 AIRCRAFT FtEGISTRATION APPLICATION CEFfr: ISSUE DATE REG ISTRAAT NUMBER N L4 a 31-1— AIRCRAFT MANUFACTURER 8 & Ci ( cSfre_O-Syl Z oz.trOSpla ®-1V eletRAFT SERIAL No. 108 Se FOR FAA USE ONLY TYPE OF REGISTRATION (Check One box) 0 I. Individual 02. Partnership O3. Corporation 04. Co-Owner 0 S. Government 0 8. Nan-Citizen Corporation 0 9. Non-Citizen Corporation Co-Owner NMIE OR APPLICANT (Pince(s: shown on evkonce a' ownership. N Individual. give last name. first name, and mkkle Me.) E TE G E 4,1 u_l__C- TELEPHONE NUMBER ( ) ADDRESS remanent meting address for fest applicant on NM At an 4 wed- Phakel Sea mint to b shown) Number and street Cale) 0 Rea 6=6( 6)0,21,4-tr , a 3 i Rural Route: •Box: CT' 81ICIE Zr 030E Sk ". :CVO WiLLS 0 5\I I, 0080a. 0 CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS ATTF_NTIONI Read the following statement before signing this application. This portion MUST be completed. A two or dishonest answer to any question in des Natal an may be grounds for punishment by fine and/or Imprisonment (U.S. Cods, TIN IS. S.C. 1001). aut. gut' CERTIFICATION WE CERTIFY: (1) met the above War is owned by the undreamed *Parent, who is • oldron eindaadO9 doredredortO 01 the United Swat iFer voting trust, give nem* or trite* ), Or: CHECK ONE AS AFEIDEBLUE: O. 0 A reeilent lien, with an registration (Form 1-151 or Form 1-561) Ne. b. 0 A non.atizen coroomt on organIzed and doing Lateness undo- Belem of Istatet and sold okra is bawd and primarily used in the United States. ROOKS a llicta haus are ISMS for InilpeCtOn at (7) That the aircraft is not rep}stened under the Wesel wykineen country; and P) That legal evidence of ownership Is etteehed Cr has been lied wen the Federal Aviation Administration. NOTE: If executed for co-ownership all applicants must sign. Use reverse side if necessary. TYPE OR PRINT NAME BELOW SIGNATURE SIGNATURE TIRE DATE EACH PART OF THIS APPLICATION MUST BE SIGI4E0 IN INK. k d kanat. er SIGNATURE TME DATE SIGNATURE TITLE DATE NOTE Pending receipt of the Certificate of Mere Registration, the aircraft may be operated the a period not in excess or 90 days, dunng Mach time the PINK copy of this applicabon mat be ranted in the aircraft. AC Fenn 80501 (5/12) (NSA 0052-00-628.9007) EFTA00313129