FAA Form 8130-6: Application for U.S. Airworthiness Certificate

Enter the registration mark, aircraft manufacture's or builder's name, aircraft model designation, yr. mfr., aircraft serial no., engine manufacture's or builder's name, engine model designation, number of engines, propeller manufacture's or builder's name and propeller model designation.

Application is hereby made for: (Check applicable items). Standard airworthiness certificate (Indicate category): normal, utility, acrobatic, transport, commuter, balloon, other.

A. REGISTERED OWNER (As shown on certificate of aircraft registration): enter NAME and ADDRESS. IF DEALER, CHECK HERE.

B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete items as indicated). AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No. and Revision No.). AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number of the last AD SUPPLEMENT available in the biweekly series as of the date of application).

Only if an STC is incorporated: SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated).

C. AIRCRAFT MAINTENANCE RECORDS: MAINTENANCE RECORDS ARE IN COMPLIANCE WITH APPLICABLE 14 CFR REQUIREMENTS. TOTAL AIRFRAME HOURS. EXPERIMENTAL ONLY (Enter hours flown since last certificate issued or renewed).

D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft, that the aircraft is registered with the Federal Aviation Administration in accordance with Title 49 of the United States Code 44101 et seq. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested. Enter the DATE OF APPLICATION, NAME AND TITLE (Print or type) and SIGNATURE.