Piper Malibu PA-46-310P Pilot Operating Handbook page 217

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Form Approved
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MAJOR REPAIR AND ALTERATION
0MB No. 2120-0020
US Depar1men1
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use Only
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Transportation
Office Id
federal Aviation
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Admkllstrotlon
INSTRUCTIONS: Print or type all entries. See FAR 43.9, FAR 43 Append ix 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 not to exceed $1,000
for each such violation (Sectio.n 901 Federal Aviation Act of 1958).
Make
Piper
Model
1. Aircraft
Serial No. Nationality and Registration Mark
Name (As shown on registration certificate)
Address (As shown on registration certificate)
2. Owner
3. For FAA Use Only
1
The data 1denttftld herein
COfflpUal with the appHcable
akwofWnea
requirements and 11 app,ov9d for duplication on Identical alrorlft
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make, model, and altered configuration when accomplished by the
original
mod1fier."
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4. Unit Identification 5. Type
Unit
Make Model Serial No. Repair Alteration
AIRFRAME
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.,.,. ., (As described in Item 1 above) .,..,.,.,._,._.,..,. .,.
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POWE RP
LANT
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PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address B. Kind of Agency C. Certificate No.
Skytech, Inc.
U.S. Certificated Mechanic
Foreign Certificated Mechanic
P.o.Box 4942
LF1R294K
Baltimore, MD 21220
X
Certificated Repair Station
Manufacturer
D. I certify that the repair and/or alteration made to the unit(s) identified in item 4 above and described on the reverse or attachments hereto
have been made in accordance with the requirements of Part 43 of the U.S. Federal Aviation Regulations and that the information
furnished herein is true and cerrect to the best of my knowledge.
Date
14 June 1995
Signature of Authoriz;9 Individual
Charles Massanopoli
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7. Approval for Return',Jo _$irvlce
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
IX
APPROVED
D
REJECTED : ·
FAA Flt. Standards
Manufacturer
Inspection Authorization
Other (Specify)
Inspector
BY
FAA Designee X Repair Station
Person Approved by Transport
Canada Airworthiness Group ·
Date of Approval or Rejection Certificate or Signature of Authorized Individual
Charles Massanopoli
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Designation No.
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15 June 1995
LF1R294K
FAA Form 33t
111-1:=
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