- HOLDER (Girt 3 CERTIFICATED MECHANIC (Gist orri(inar &Nisi) 6 CERTIFICATED REPAIR STATION (Gut Ctrieitatt No.) 5" AIRCRAFT MANUFACTURER (Gist Nagle of Firm) DATE TDIE SIGNATURE I V. FAA REPRESENTATIVE CERTIFICATION (Check ALL. applicable blocks). . Iliad that the aircraft described in Se