Piper Malibu PA-46-310P Pilot Operating Handbook page 196

0
Fonn Approved
MAJOR REPAIR AND ALTERATION
0MB No. 2120-0020
US Depat1ment
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
of Transportation
Office Identification
Federal Avllltion
Admlnls1ralion
INSTRUCTIONS: Print or type
au
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 civil penalty not
to
exceed $.1,000
for each such violatiOn (Section 901 Federal Aviation Act of 1958). ·
Make
Model
Piper
PA46-310P
1. Aln:raft
Serial No.
Natio,-iality and Registration Mark
USA.
Name (As shown on registration certificate) Address (As shown on registration certificate)
2. Owner
3. For FAA Use Only
..
4.Unttldentiflcation 5.Type
Unit Make Model Serial No. Repair Alteration
AIRFRAME
(As described
in
Item 1 above)
X
POWERPLANT
PROPELLER
----
-- ~-- -
-
- ..... ••. :. • ~..l..· .:.-.....---·-
----~
--
--
Type
APPLIANCE
Manufacturer
6. Confonnity Statement
A. Agency's Name
and
Address B. Kind of Agency C. Certificate No.
Mead Aircraft Services, Inc.
X
U.S. Certificated Mechanic
A&P 443641987
648 Arrowhead Rd
Foreian Certificated Mechanic
Inman, KS 67546
Certifica1ed Reoalr
Station
Manufacturer
D. I certify that the repair and/or alteration made
to
1he unit(s) identified in item 4 above and desaibed 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 1he information
furnished herein is true
and
coned
to
the
best of
my
knowledge.
-
Date
Signature of Aulhorized
~
.
8-27-04
vVJ,eQI
~ - ~
keu,,
7. Approval for Return To Service
Pursuant
to
1he authority given persons specified below, the unit identified in item 4 was ins= in the manner prescribed by the
Administrator
of the
Federal Aviation Administration and is (x APPROVED REJECTED
FAA Flt. Standards
Manufacturer
X Inspection Authorization
Other
(Specify)
Inspector
BY
FAA Designee Repair Station
Person Approved by Transport
canada Airworthiness Group
-
DateofAppR>ValorRejection
Certificate or
Signature of ~utt,o~ lndivid~v •
8-27-04
Designation No.
VVZ~c-4.
IA 443641987
~
-C
l<ev,"
FAA Fonn 337
(12-88)