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3OMB No. 2120-0020
Electronic Tracking Number
Exp: 5/31/2018
MAJOR REPAIR AND ALTERATION
US Department
For FAA Use Only
of Transportation
(Airframe, Powerplant, Propeller, or Appliance)
Federal Aviation
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.
1. Aircraft
Make
Model
Series
Name (As shown on registration certificate)
Address (As shown on registration certificate)
Address
2. Owner
City
State
Zip
Country
3. For FAA Use Only
4. Type
5. Unit Identification
Repair
Alteration
Unit
Make
Model
Serial No.
(As described in Item 1 above)
AIRFRAME
POWERPLANT
PROPELLER
Type
APPLIANCE
Manufacturer
6. Conformity Statement
A. Agency's Name and Address
B. Kind of Agency
U. S. Certificated Mechanic
Manufacturer
Name
C. Certificate No.
Foreign Certificated Mechanic
Address
Certificated Repair Station
City
State
Certificated Maintenance Organization
Zip
Country
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.
Signature/Date of Authorized Individual
Extended range fuel
per 14 CFR Part 43
App. B
7. Approval for Return to Service
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
Approved
Rejected
FAA Flt. Standards
Persons Approved by Canadian
Maintenance Organization
Manufacturer
Department of Transport
Inspector
BY
Other (Specify)
Inspection Authorization
FAA Designee
Repair Station
Certificate or
Signature/Date of Authorized Individual
Designation No.
FAA Form 337 (10/06)
Page 1
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