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on S. Type Unit Make Model I._ Senal No. i Repair Aittration AIRFhAME . • (As darned' Item I above XX POWERPLANT PROPELLER 1 ' I Aetna Type ..,- i . Maistachne• 6. Contomaty Stliallallee A. Agency's Name end Address ). Kind ci APR*•• • : i•• C. Ceara' No. • LANCE A. MATT
C. Canifiewa No. Z 11.1.C— ertecated Wenn.< • • AP 1864049 \ - LANCE -A. MATTESON . ' 2407 EAST SHEA BLVD. . PHOENIX, ARIZONA 85028 Fan. Canaan° Lot-n.4 ' Congesiad Remo Simon Menotarkeee . .../ D. I comfy thattWi101it andimaltanton maw to me °win ciontareo in non • now: ono oltalloa on
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