Cub Crafters CARBON CUB SS CC11-160 Maintenance Manual page 13

CHANGE OF ADDRESS/OWNERSHIP FORM
Aircraft Serial Number: CC11-
CURRENT OWNER (Last, First)
COMPANY/ORGANIZATION
PREVIOUS ADDRESS
Number and Street
City
State/Province
Country
TELEPHONE NUMBER(S)
SIGNATURE
Change of Ownership/Address Log Number:
Manual number SSC10000AMM
Date: 04/18/2013
CUB CRAFTERS, INC.
CC11-160 MAINTENANCE MANUAL
Aircraft Registration Number:
NEW OWNER (Last, First)
COMPANY/ORGANIZATION
NEW ADDRESS
Number and Street
City
Postal Code State/Province
Country
TELEPHONE NUMBER(S)
DATE
FOR CUB CRAFTERS' USE ONLY
Date Received:
Postal Code
1
Page: 3