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US D . p u b n m
MAJOR REPAIR AND ALTERATION
or
Tnnpor(rlion
(Airframe, Powerplant, Propeller, or Appliance)
F-A*
.
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AdnH.b.llon
I
INSTRUCTIONS: Print or
lype
a1 entries. See FAR 43.9, FAR 43 Appendix 0, and AC 43.91
(or
subsequent mvision themof) for instructions
and disposition of this form. f his nport is raquksd by
Law (40 U.S.C. 1421). Failun
to
nport
can
n w k
in civil pnelty
not
to
exceed $1,000
for each such violetion (Sadion 901 F&ml Aviation Act of 1958).
1
2. -r
1
Luxury A i r Management, Inc
1. Airclaft
I
30 Old Rudnick Lane
Dover, D E 19901
4. Unit Identification
&%!?
M s M
Piper
-I
No.
28R-7635256
Namo (As
shown on
regrjtratbn w t t h t e )
I
Unit
I
MO(I(H
PA-28R-200
Nathnal'i and Registration Mark
N323MG
Addmss (As shorn
on
-stration
~~)t?iticate)
Make
I
Model
Serial No.
I
Repir
I
Alterabon
-
(As desctibed in Item 1 above)
I
I X
POWERPLANT
I
I
PROPELLER
APPLIANCE
Form Approved
OM0
No.
21204020
For FAA
U . .
Only
offlca Identilicelion
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D I c e w that the repair
and/or
afteration made to
the
unit@) identifRd in item
4
above and
desaibed
on
Vie reverse
or
attachments heceto
have been made in accordance with
the
requirements of Part 43
o f the
U.S. Federal Avialion Regulations
and
that
the
informalion
furnished herein is ttue
and axred
to
the
best of my knowledge.
I
I
I
I
I
6. Conformity Statement
Date
10-19-2000
I
Pursuant b the aulhonty given persons specified
below,
the unil identified in item
4
was in
~n Vie manner pmsuibed by
the
Administrator of the Federal Aviation Administretion
and
is
APPROVED
y '
REJECTED
C. Cetiicate No.
- -
A1291728591
A. Agency's Name and Address
Chris Moyers
Aero A v i a t i o n Training Center, I n c .
4510 Airport Rd.,
Hangar 1
C i n c i n n a t i , Ohio 45226
B. Kind of Agency
X
otIw
--
U.S. Cettificat.d Wchank
Foreign C e t i i t e d
Mechanic
C e t i i i Repair Station
Manufacturer
~~A~
Canada
~~ w
Ainvorthiness
bY T m n a ~ M
Grap
BY
Dateof
Approval orRepcfion
4 r
940
0
FAA Rt Standards
Inspector
FAA Designee
Uanufechrrer
Repair Stabon
FAA
Fonn
337
(12-98)
c d l k a t e
or
DeJiOnation No.
/9Y3dk?
v
Signature of Authofized Individual
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