,, OMBNo.2120-0020IElectronicTrackingNumber
Exp: 8/3112014
USDepartment MAJOR REPAIR AND ALTERATION ForFAAUseOnly
of Transportation (Airframe, Powerplant, Propeller, or Appliance)
FederalAviation
Administration
INSTRUCTIONS: Print or type all entries. See Title 14 CFR §43.9, Part 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. §44701). Failure to report can result in a civil penalty for each
such violation. (49 U.S.C. §46301(a))
Nationality and Registration Mark Serial No. 36106
USA N223JC
1. Aircraft Make Model ISeries
Bell Helicopter Textron Canada Ltd. 412EP
Name (As shown on registration certificate) Address (As shown on registration certificate)
Aircraft Associates Inc. Address POBox2190
2. Owner City Manassas State VA
Zip 20108-0826 Country USA
3. For FAA Use Onlv
-
4. Type 5. Unit Identification
Repair Alteration Unit Make Model Serial No.
D 0 AIRFRAME (As described in Item 1above)
D D POWERPLANT
D D PROPELLER
Type
D D APPLIANCE Manufacturer
6. Conformity Statement
A. Agency's Name and Address B. Kind of Agency
Name AircraftAssociatesInc. x U. S. Certificated Mechanic I Manufact,uer
Address 10678Avtatlon Ln ForeignCertificated Mechanic C. Certificate No.
City Manassas State VA Certificated Repair Station 3393868
Zip 20110-2700 Country USA Certificated Maintenance Organization
D. I certify that the repair and/or alteration made to the unit(s) identified in item 5 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 correct to the best of my knowledge.
Extended range fuel s;gaaMelD•~jJ h-,,
per 14 CFR Part 43 0 .3/z7/1s-
App. B
7. Aocroval for Return tlrService
Pursuant to the authority given persons specified below, the unit identified in item 5 was inspected in the manner prescribed by the
Administrator of the Federal Aviation Administration and is nApproved nRejected
FAA Flt. Standards Manufacturer Maintenance Organization IPersons Approved by Canadian
Inspector Department of Transport
BY x Other (Specify)
FAA Designee Repair Station Inspection Authorization
Certificate or s;ga,Wz/z;j
Designation No. 3 I()1/,s
3L/bll lfo . 0
FAAForm 337 {10/06) IPageI
