ony USA 3. For FAA Use Only 4. Type 5. Unit Identilkation Repair Alteration Una Make Model Serial No. El 0 (As eaSenDed,n nem i abate) A/RFRAME O O POIAERPtAP4T O O PROPELLER 0 O APPLIANCE Type Manutedwar S. Conformity SO ement A. Agency's Name and Address B. Kind of Agency ser

r Gummy UM/ 4 6. TO Ideatilkr Defined City 'JEW r K. Siam greeter/ y 7. bisulicel Mlles 4 8. Statute Mlles /760t 9. OeIlons Y729 A/RFRAME )7 es 10. Pan* 24789 O. nisbtnne 3 .4" 12. Altitude FL 3270 3,3 I 13. 20. NiEbt a T2 I/ I 14. 21. 15. 22 IMO . APProaCh 16. 23