Faa Form 7711-2 - Application For Certificate Of Waiver Or Authorization Page 2
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1
2
3No certificate may be issued unless a completed application
form has been received (14 C.F.R. 91, 101, and 105).
Form Approved: O.M.B. No. 2120-0027 10/31/2015
US Department of Transportation
APPLICANTS - DO NOT USE THESE SPACES
Region
Date
Federal Aviation Administration
Action
APPLICATION FOR
Approved
Disapproved - Explain under "Remarks"
CERTIFICATE OF WAIVER
Signature of authorized FAA representative
OR AUTHORIZATION
INSTRUCTIONS
Submit this application in triplicate (3) to any FAA Flight
fighting equipment. The applicant may also wish to submit
Standards district office.
photographs and scale diagrams as supplemental material
to assist in the FAA's evaluation of a particular site.
Applicants requesting a Certificate of Waiver or Authoriza-
Application for a Certificate of Waiver or Authorization must
tion for an aviation event must complete all the applicable
be submit- ted 45 days prior to the requested date of the
items on this form and attach a properly marked 7.5 series
event.
Topographic Quadrangle Map(s), published by the U.S.
Geological Survey (scale 1:24,000), of the proposed operat-
Applicants requesting a Certificate of Waiver or Authoriza-
ing area. The map(s) must include scale depictions of the
tion for activities other than an aviation event will complete
flightlines, showlines, race courses, and the location of the
items 1 through 8 only and the certification, item 15, on the
air event control point, Police dispatch, ambulance, and fire
reverse.
1. Name of organization
2. Name of responsible person
3. Permanent
House number and street or route number
City
State and ZIP code
Telephone No.
mailing
address
4. FAR section and number to be waived
5. Detailed description of proposed operation (Attach supplement if needed)
6. Area of operation (Location, altitudes, etc.)
7a. Beginning (Date and hour)
b. Ending (Date and hour)
8.
Aircraft
Certificate number
Home address
Pilot's Name
make and model
and rating
(Street, City, State)
(b)
(a)
(c)
(d)
FAA Form 7711-2
(6-86) Supersedes Previous Edition
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