RD Aircraft Registration 42.k - 0.217.4 Owner's Name CaCO:d./..dricS 74 , 511 Serial No of Entry 1 Mod/Repair Ref. No. 2 Description of Mod/Repalt 3 Mod/Repair Approval Reference 4 Entry Serial No of other Mods/Repairs Affected 6 Person Certifying, Authority. Signature and Cite 8