Faa Form 8110 14 PDF Details

The FAA Form 8110-14 is a mandatory form that is used for registering aircraft with the Federal Aviation Administration. The form must be filled out and submitted to the FAA within 20 days of an aircraft's initial flight. The form can be processed online or by mail, and applicants are required to provide specific information about their aircraft including its make, model, serial number, and owner. In addition, the form requires the signature of the applicant as well as contact information. Filling out this form is critical for ensuring that your aircraft is registered with the FAA and in compliance with federal regulations.

QuestionAnswer
Form NameFaa Form 8110 14
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names8110 14 faa form, 8110 statement, faa form 811014, 8110 14

Form Preview Example

U.S. Department of Transportation

Federal Aviation Administration

INFORMATION FOR APPLICANT

STATEMENT OF QUALIFICATIONS (DAR - DMIR - DER)

Privacy Act Statement

Information on this form is solicited under authority of 14 CFR Part 183. The purpose of this information is to evaluate your application and establish your qualifications as a designee. Submission of the data is m mandatory except for your Social Security Number which is voluntary. Incomplete submission may result in delay or denial of your request. The data will be used to determine your eligibility for the designation sought, and will become part of the Privacy Act system of records DOT/FAA 830, Representatives of the Administrator, and is subject to the following routine uses as published in the Federal Register: (1) To provide the public with the names and addresses of certain categories of representatives who may provide service to them; and (2) DOT's Prefatory Statement of General Routine Uses.

The submission of your social security number is voluntary. If provided, it will be used for record keeping purposes and to help prevent your records from being confused with another person of the same name.

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0033. Public reporting for this collection of information is estimated to be approximately 30 minutes to 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are required to obtain or retain benefits per 14 CFR Part 183. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence

Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110.

Tear off this cover sheet before submitting this form.

FAA Form 8110-14 (1/12) Supersedes Previous Edition

FAA Form 8110-14, Statement of Qualifications

Organizations complete only the applicable blocks and attach separate resumes with the names, signatures, titles, and qualifications of those persons who would actually perform the authorized functions.

 

STATEMENT OF QUALIFICATIONS

 

 

OMB-2120-0033

 

 

 

 

Expiration Date 08-31-2013

 

 

 

 

 

 

US Department of Transportation

 

 

(DAR-DMIR-DER)

 

 

3. U.S. CITIZEN

 

Federal Aviation Administration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS: Print or type all entries except signatures

 

 

Yes

No

 

 

 

 

 

 

 

1. NAME (Last, first, middle) OR ORGANIZATION

 

 

 

 

 

 

 

 

 

 

 

2. BUSINESS OR COMPANY ADDRESS (Number, street, city, state, and ZIP code)

 

 

4. DATE OF BIRTH

 

 

 

 

 

 

 

 

 

5. BUSINESS PHONE NUMBER

 

 

6. BUSINESS FAX NUMBER

 

7. EMAIL ADDRESS

 

 

 

 

 

 

 

 

 

8. DESIGNATION SOUGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Designated Engineering

 

Structural Engineering

 

Engine Engineering

 

Representative (DER)

 

 

 

 

 

 

 

Powerplant Engineering

 

Propeller Engineering

 

 

 

 

 

 

 

Company

 

Systems and Equipment Engineering

 

Flight Analyst

 

 

 

 

 

 

 

Consultant

 

Acoustical Engineering

 

Flight Test Pilot

 

 

 

 

 

 

 

Manufacturing Function(s)

 

 

 

Note:

 

 

 

 

 

 

Designated Airworthiness Representative (DAR)

A separate application must be submitted for each

 

 

 

 

 

 

 

 

discipline, i.e., Manufacturing or Engineering.

Designated Manufacturing Inspection Representative (DMIR)

 

 

 

 

 

 

 

 

 

Applicants shall identify specific function(s) for which appointment is sought:

 

 

 

 

9.EXPERIENCE RESUME FOR NUMBER OF YEARS, AS APPROPRIATE, PERTINENT TO DESIGNATION SOUGHT. (Use additional sheets if necessary)

Dates

From

To

 

 

 

 

Employer’s Name

Position Title and Duties

10. EDUCATION AND TRAINING HIGH SCHOOL LEVEL AND ABOVE PERTINENT TO DESIGNATION SOUGHT.

Dates

From

To

 

 

Name of School

Curriculum or Study Program

Degrees Received

11. FAA CERTIFICATES NOW HELD PERTINENT TO DESIGNATION SOUGHT.

Type

Certificate No.

Rating

Date Each Rating Issued

12. EMPLOYER’S RECOMMENDATION:

I recommend the person identified above be appointed as:

 

 

Designated Engineering Representative

 

 

Designated Manufacturing Inspection

 

 

Designated Airworthiness Representative

 

 

 

 

 

Representative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

Primary Business

Signature

13. LOCATION WHERE DESIGNEE FUNCTIONS WILL BE PERFORMED IF DIFFERENT THAN BLOCK 2.

Address

Telephone Number

EMAIL Address (Optional)

14.CERTIFICATION: I certify that the above statements are true to the best of my knowledge and that I am familiar with the Federal Aviation Regulations pertinent to the designation sought.

Date

Signature

FAA Form 8110-14 (1-12) Supersedes Previous Edition

Electronic Format PDF

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Writing section 1 of 811014

2. Soon after the first part is filled out, proceed to type in the applicable details in these - FAA CERTIFICATES NOW HELD, Certificate No, Type, Date Each Rating Issued, EMPLOYERS RECOMMENDATION I, Designated Engineering, Designated Manufacturing Inspection, Designated Airworthiness, Representative, Date, Primary Business, Signature, LOCATION WHERE DESIGNEE FUNCTIONS, Address, and Telephone Number.

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