AIRCRAFT # 3
AIRPORT WHERE AIRCRAFT PRIMARY HOME BASED - CITY
COUNTY
STATE
REGISTRATION “N” #:
AVIONICS AND EXTRA EQUIPMENT
MFG. NAME: (MAKE)
MODEL NAME OR #:
YEAR BUILT:
SERIAL NUMBER:
DATE PURCHASED
PURCHASED: NEW [
]
USED [
]
COST:
HOURS BETWEEN OVERHAULS (TBO):
HOURS SINCE LAST OVERHAUL:
NOTE: Please submit a copy of your log book to substantiate T.B.O.
LAST OVER HAUL: MAJOR [
]
TOP [
]
and airframe hours.
TOTAL HOURS ON AIRFRAME AS OF JAN. 1:
AIRCRAFT # 4
AIRPORT WHERE AIRCRAFT PRIMARY HOME BASED - CITY
COUNTY
STATE
REGISTRATION “N” #:
AVIONICS AND EXTRA EQUIPMENT
MFG. NAME: (MAKE)
MODEL NAME OR #:
YEAR BUILT:
SERIAL NUMBER:
DATE PURCHASED
PURCHASED: NEW [
]
USED [
]
COST:
HOURS BETWEEN OVERHAULS (TBO):
HOURS SINCE LAST OVERHAUL:
LAST OVER HAUL: MAJOR [
]
TOP [
]
NOTE: Please submit a copy of your log book to substantiate T.B.O.
TOTAL HOURS ON AIRFRAME AS OF JAN. 1:
and airframe hours.
AIRCRAFT # 5
AIRPORT WHERE AIRCRAFT PRIMARY HOME BASED - CITY
COUNTY
STATE
REGISTRATION “N” #:
AVIONICS AND EXTRA EQUIPMENT
MFG. NAME: (MAKE)
MODEL NAME OR #:
YEAR BUILT:
SERIAL NUMBER:
DATE PURCHASED
PURCHASED: NEW [
]
USED [
]
COST:
HOURS BETWEEN OVERHAULS (TBO):
HOURS SINCE LAST OVERHAUL:
NOTE: Please submit a copy of your log book to substantiate T.B.O.
LAST OVER HAUL: MAJOR [
]
TOP [
]
and airframe hours.
TOTAL HOURS ON AIRFRAME AS OF JAN. 1:
Is there anything functionally wrong with your aircraft? Yes [ ] No[ ].
NAME OF PURCHASER: ________________________________
If yes, please provide the Board of Assessors with information in order
ADDRESS: ___________________________________________
for them to make a proper assessment. (List Below)
CITY, STATE, ZIP: ______________________________________
DATE SOLD: ______________ SALE PRICE: _______________
If you sold or traded your aircraft and did not own on January 1,
DESCRIPTION ________________________________________
this year, this section should be completed in order for the items
to be removed from your account.
NAME: _______________________________________________
If purchased used this year, list the name and address of
ADDRESS: ___________________________________________
the previous owner.
CITY, STATE, ZIP: ______________________________________
List anything functionally wrong with your aircraft:
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