
5. AIRCRAFT SERIAL NO. 6. ENGINE BUILDER’S NAME (Make) 7. ENGINE MODEL DESIGNATION
8. NUMBER OF ENGINES 9. PROPELLER BUILDER’S NAME (Make) 10. PROPELLER MODEL DESIGNATION 11. AIRCRAFT
IMPORT
NO
FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE
Form Approved OMB No. 2120-0018
Expires: April 30, 2021
APPLICATION FOR
INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for
U.S. Department
U.S. AIRWORTHINESS
FAA use only. Submit original only to an authorized FAA Representative. If
of Transportation
additional space is required, use attachment. For special flight permits
Federal Aviation
CERTIFICATE
complete Sections II, VI, and VII as applicable.
Administration
1. REGISTRATION MARK 2. AIRCRAFT BUILDER’S NAME (Make) 3. AIRCRAFT MODEL DESIGNATION 4. YR. MFR. FAA CODING
N
TAF
IO
AIRCR
TIPCRS
I.
DE
IS (Check if applicable)
APPLICATION IS HEREBY MADE FOR:
(Check applicable items)
A 1 STANDARD AIRWORTHINESS CERTIFICATE (Indicate category)
RMAL UTILITY ACROBATIC TRANSPORT COMMUTER BALLOON OTHER
B SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items)
7
PRIMARY
9
LIGHT-SPORT (Indicate Class) Airplane Power-Parachute Weight-Shift-Control Glider Lighter than Air
2 LIMITED
1 CLASS I
5
PROVISIONAL (Indicate class)
2 CLASS II
1 AGRICULTURE AND PEST CONTROL 2 AERIAL SURVEY 3 AERIAL ADVERTISING
RESTRICTED (Indicate operation(s)
3
4 FOREST (Wildlife conservation) 5 PATROLLING 6 WEATHER CONTROL
to be conducted)
D
0 OTHER (Specify)
ET
1 RESEARCH AND DEVELOPMENT 2 AMATEUR BUILT 3 EXHIBITION
SQUE
4 AIR RACING 5 CREW TRAINING 6 MARKET SURVEY
N RE
0 SHOW COMPLIANCE WITH THE CFR 7 OPERATING (Primary Category) KIT BUILT AIRCRAFT
8
A
Existing aircraft without an airworthiness certificate & do not meet § 103.1
IOICAT
OPERATING
8
8
B
Operating Light-Sport Kit-built
LIGHT-SPORT
IF
EXPERIMENTAL (Indicate operation(s)
4
RT
to be conducted)
Operating light-sport previously issued special light-sport category airworthiness
8
C
CE
certificate under § 21.190
. II
9
A
RESEARCH AND DEVELOPMENT
UNMANNED
9
9
B
MARKET SURVEY 9D EXHIBITION
AIRCRAFT
9
C
CREW TRAINING 9E SHOW COMPLIANCE WITH THE CFR
1 FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE
SPECIAL FLIGHT PERMIT
(Indicate
2 EVACUATE FROM AREA OF IMPENDING DANGER
operation to be conducted, then complete Section
8
3 OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT
VI or VII as applicable on reverse side)
4 DELIVERING OR EXPORTING 5 PRODUCTION FLIGHT TESTING
6 CUSTOMER DEMONSTRATION FLIGHTS
C 6
MULTIPLE AIRWORTHINESS CERTIFICATE
(Check ABOVE “Restricted Operation” and “Standard” or “Limited” as applicable)
A. REGISTERED OWNER (As shown on certificate of aircraft registration) IF DEALER, CHECK HERE
NAME ADDRESS
B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete items as indicated)
NIO
AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No. and AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the
ICAT
Revision No.) number of the last AD SUPPLEMENT available in the biweekly series as of the date of application)
IF
AIRCRAFT LISTING (Give page number(s)) SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated)
RT CER’S
C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
NE
CHECK IF RECORDS IN COMPLIANCE TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Enter hours flown since last certificate
WITH 14 CFR section 91.417
3
issued or renewed)
W OI.II
D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, 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.
DATE OF APPLICATION NAME AND TITLE (Print or type) SIGNATURE
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183(d) applies)
N
N
IO
14 CFR part 121 CERTIFICATE HOLDER CERTIFICATED MECHANIC (Give Certificate No.)
CERTIFICATED REPAIR STATION (Give Certificate No.)
IO
2 3
CT
Y
6
ICAT
(Give Certificate No.)
E
NC
P
AGE
AIRCRAFT MANUFACTURER (Give name or firm)
5
INS
RIF
.
E
DATE TITLE SIGNATURE
IV
V
(Check ALL applicable block items A and B)
THE CERTIFICATE REQUESTED
E
A. I find that the aircraft described in Section I or VII meets
IV
N
4 AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE
IO
requirements for
AT
AA
NT
ICAT
B. Inspection for a special flight permit under Section
FAA INSPECTOR FAA DESIGNEE
F
E
VII was conducted by:
CERTIFICATE HOLDER UNDER 14 CFR part 65 14 CFR part 121 OR 135 14 CFR part 145
.
S
IF
V
RE
RT
DATE MIDO/FSDO FAA INSPECTOR’S SIGNATURE or DESIGNEE’S
FAA INSPECTOR’S CERTIFICATION FILE REVIEW SIGNATURE
P
CE
OFFICE SIGNATURE AND NO.
RE
4 1
FAA Form 8130-6 (06/20) SUPERSEDES PREVIOUS EDITION Page 1 of 2