~CIRRUS ~AIRCRAFT

~CIRRUS ~AIRCRAFT

Cirrus Design Corporation 4515 Taylor Circle Duluth, MN 55811

01*20427 Sold Cirrus FSC - TYS

114 Cirrus Landing Alcoa TN 37701 United States

To

Phone: 218-727-2737 Fax: 218-727-2148

www.cirrusaircraft.com

Ship

To

Item Product and Description UOM

0001 70644-002 EA KIT, AVIONICS SYSTEM ELEC TRONIC CONTENT

Above Items contain the followings components

31146-011 UNLOCK DATACARD, RADAR AL TIMETER 31146-012 UNLOCK DATA CARD, EMERGENC YAUTOLAND 53122-016 DATA CARD, SO, 16GB -

\.____ 39593-034 SCD, SF 50 GAR MIN SYSTEMS OFTWARE, 2881. C4 Country of Origin: US HTS: 8803300010

Tracking Number: 188353600320

( 1 ·- 7 - / r-··-·1 \. ... £ftA.1 -t'_). ---~ V'1 (l<-L)(:,../

Director, Quality Assurance

CERTIFICATE OF CONFORMANCE

Cirrus Aircraft certifies that the items shipped on this order are in compliance with all engineering drawings and specifications, and meet all quality contro l specifications set forth.

All items listed above are considered airworthy, meet the requirements of U.S. Type Certificates A00009CH or A00018CH and were manufactured under U.S. Production Certificate PC338CE.

Items are eligible for installation on Cirrus model SR20, SR22, SR22T and SF50 as allowed by the applicable AMM.

Please reference the latest revision of Cirrus Aircraft Authorized Service Center eProcedures for information on non-warranty RMAs, warranty claims, shipping damage or

'---· discrepancies.

Cirrus Direct Parts [email protected]

Part Returns

Page 1 of 2

Wbr?7JOJ( ~e, }~ PACKING SLIP

PACK SLIP NO. DATE SHPPED

256738*2 09/22/20 SALES ORDER NO. DATE ORDERED

256738 09/01/20 CUSTOMER PURCHASE ORDER NO.

TYS14333 SHIP VIA INCOTERMS

FedEx Priority Overnight FCTRY-PPD

20427 Cirrus FSC - TYS 114 Cirrus Landing Alcoa, TN 37701 United States

QTY QTY QTY Serial Numbers Ordered Shipp~B.O.

1 C) g'j/) 1 1

J c/J-3 /J oJ.O 1 1

1 1

1 1

~CIRRUS ~AIRCRAFT \..__




To

Phone: 218-727-2737 Fax: 218-727-2148


Ship

To


[email protected]

Accounting [email protected]

Warranty Claims [email protected]

Cirrus Aircraft holds U.S. Federal Explosives License 3-MN-137-21 -0L-00527.


~ Cirrus Aircraft certifies that the items shipped on this order are in compliance with all engineering drawings and specifications, and meet all quality control specifications set forth.



Please reference the latest revision of Cirrus Aircraft Authorized Service Center eProcedures for information on non-warranty RMAs, warranty claims, shipping damage or discrepancies.


Part Returns [email protected]



Cirrus Aircraft holds U.S. Federal Explosives License

'-- 3-MN-1 37 -21 -0L-00527.

Page 2 of 2

l» b {';ob (,

PACKING SLIP PACK SLIP NO. DATE SHPPED






QTY QTY QTY Serial Numbers Ordered Shipped 8.0.

o~CIRRUS ~AIRCRAFT

\____. Cirrus Design Corporation 4515 Taylor Circle Duluth, MN 55811

Sold

To

01*20427 Cirrus FSC - TYS 114 Cirrus Landing Alcoa TN 37701 United States

Phone: 218-727-2737 Fax: 218-727-2148

www .cirrusaircraft.com

Ship

To


0001

' !'---

39591-002 ASSY, THUMBWHEEL, CHECKLIST Country of Origin: US Schedule 8 : 8803300010

Model SFSO SIN 0186

Tracking Number: 937200344450

( 'I i/ (- -- -,

\. .... .L'"l.'-1 //'\ Lv/ (l.ol.i.O•J

Director, Quality Assurance


Cirrus Aircraft certifies that the items shipped on this order are in compliance with all engineering drawings and specifications , and meet all quality control specifications set forth.







Warranty Claims warranty@cirrusaircraft .com

Cirrus Aircraft holds U.S. Federal Explosives License 3-MN-137-21-0L-00527.

EA

Page 1 of 2

,f\J Cf q 5 L C.. w/ CJ ;). 3(() I /




TYS14658 SHIP VIA

FedEx Priority Overnight


I

QTY Ordered

QTY QTY Shipp~ 8.0.

INCOTERMS

FCTRY-PPD

Serial Numbers

~ CIRRU·S ,~A I R CRAFT

\.____. Cirrus Design Corporation 4515 Taylor Circle Duluth, MN 55811



To

Phone: 218-727-2737 Fax: 218-727-2148


Ship

To



Cirrus Aircraft certifies that the items shipped on this order are in compliance with all engineering drawings and specifications, and meet all quality control specifications set forth.


Items are eligible for installation on Cirrus model SR20, SR22, SR22T and SF 50 as allowed by the applicable AMM.

'---"' Please reference the latest revision of Cirrus Aircraft Authorized Service Center eProcedures for information on non-warranty RMAs, warranty claims, shipping damage or discrepancies.





Cirrus Aircraft holds U.S. Federal Explosives License 3-MN-137 -21-0L-00527.

I'-"

Page 2 of 2







QTY QTY QTY Serial Numbers Ordered Shipped 8.0.

-:t~~\

~· CIRRUS "--~AIRCRAFT


Phone: 218-788-3000 Fax: 218-727-2148


10959 Central Flying Service Inc 1501 Bond Street Little Rock AR 72202 United States

Model SF50 s/n 0186

Chg F01 Freight Expense

C~RA1" iS ,-r(':,1r.C"u-;.) Director, Quality Assurance


Cirrus Aircraft certifies that the items shipped on this order are in compliance with all engineering drawings and specifications, and meet all quality control specifications set forth.


Items are eligible for installation on Cirrus model SR20, SR22, SR22T and SF 50 as allowed by the applicable AMM.





REMI!fi~.ADDRESS:

Attn: Accounts Receivable Cirrus Design Corporation 4515 Taylor Circle t;>uh!lh,.MN 55811

\::> ,.

Page 1 of 2

INVOICE 313396 SALES ORDER NO. INVOICE DATE

248724 04/27/20 PACKING SLIP NO. DUE DATE

248724*1 05/27/20 CUSTOMER PURCHASE ORDER NO. PAYMENT TERMS

SFS0-0186 NET30 SALES REPRESENTATIVE I TAX I TAX CODE

Wendy Anderson SHIP VIA INCOTERMS

FedEx First Overnight AM FCTRY-PPD


Continued

~· CIRRUS ~AIRCRAFT


Phone: 218-788-3000 Fax: 218-727-2148


''· .~ . . J)r


Cirrus Aircraft holds U.S. Federal Explosives License 3-MN-137 ·21-0L-00527.

REMITIANCE ADDRESS:

Attn: Accounts Receivable Cirrus Design Corporation 4515 Taylor Circle Duluth, MN 55811

Page 2 of2

INVOICE 313396 SALES ORDER NO. INVOICE DATE

248724 04/27/20 PACKING SLIP NO. DUE DATE

248724*1 05/27/20 CUSTOMER PURCHASE ORDER NO. PAYMENT TERMS

SFS0-0186 NET30 SALES REPRESENTATIVE I TAX rAXCODE

Wendy Anderson SHIP VIA I NCO TERMS

FedEx First Overnight AM FCTRY-PPD

10959 Central Flying Service Inc 150 1 Bond Street Little Rock AR 72202 United States

SUBTOTAL DISCOUNT

TAX DEPOSIT 0.00

N

"" \\1

~ l! ~

,£

j

~ ~ \1

I. Approving Authority/Country:

FAA/United States

4. Organization Name and Address:

2. Number:

AUTHORIZED RELEASE CERTIFICATE 104678-0107

FAA FormS AIRWORTHINESS APPROVAL TAG 5. Work Order/Contract/Invoice

RAM Manufacturing Company, Inc. 3172 East Deseret Drive South, St George, UT 84790 (9UTR707C) Number:

181109

or Fuel Control Valve 26327-009 0263 OVERHAULED

12. Remarks:

Per contract, RSO 116 and customer approved traveler instructions, unit was overhauled, tested and re-certified. Full details held on RSO 116.

RAM Company certifies that the work specified in Block 11112 was carried out in accordance with EASA Part-145 and in respect to the work, the component is considered ready to release to service under EASA Part-145, Approval Number: EASA.I45.6800.

14a. 0 14 CFR 43.9 Return to Service 0 Other regulation specified in Block 12

Certifies that unless otherwise specified in Block 12, the work identified in Block 11 and described in Block 12 was accomplished in accordance with Title 14, Code of Federal Regulations, part 43 and in respect to that work, the items are approved for r eturn to service.

1 4c. Approval/Certificate No.:

9UTR707C

14e. Date (dd/mmm/yyyy):

14-May-2020

It is important to understand that the existence of this document alone does not automaticaUy constitute authority to install the aircraft engine/propeller/article.

Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in Block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts aircraft engine(s)/propeller(s)/article(s) from the airworthiness authority of the country specified in Block 1.

Statements in Blocks 13a and 14a do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.

FAA Form 8130- 3 (02- 14) NSN: 0052-00-01 2-9005

) )

User

Text Box

Logbook page 33

User

Text Box

Logbook Page 33

User

Text Box

Logbook Page 33

User

Text Box

Explanation of no Serial # on EI IPS PRSOV

A GAR MIN~

Flight Stream 51 0 Unit Only

p_,...,-. lllll,,loll.llllll

Serial Number: l!l liiiiiSI I IIIIIIIIUill ltllll 590002361

Declaration of Conformity Hereby, Garmin declares that this product is in compliance with the Directive 2014/53/EU. The full textoftheEU declaration of conformity is availableatlhe following internet address: www.garmin .com/compliance.

Access to operation , installation and safety information can be obtained at www.garmin.com.

Garmin International. Inc. 1200 East 151st Street, Olathe. Kansas 66062, USA

Garmin (Europe) Ltd . ( E: Uberty House Houndsdown Business Park Southampton Hampshire · S0409LR

Warning: This produa, its padcaging, and its components contain chemicals known to the State of California to cause cancer, birth defects, Of reproductive harm. This Notice is being provided in accordance with California's Proposition 65. If you have any questions or would like additional information, please refer to our website at WMY.garmin.com/prop6S/.

C2016 Garmin ltd. or its subsidiaries. All rights reserved. Garmin International Inc .. 1200 East15fst Street, Olathe. Kansas, 66062, U.S.A. Garmin {Europe) ltd.,libelt,v Hous,e, Hounsdown Business Park, Southampton, Hampshire, 5040 9LR, U.K. Garmin (Asia) Corporation, No.68, "Zhangshu 2nd Rd., Xizhi Oist., New Taipei City 221, Taiwan (R.O.C.)

@ e) ( E: A 0 Bluetooth· -The Btuetooth• word mark and logos are owned by the Bluetooth SJG, Inc.. and any use of SU<h marks by Garmin is under license.

Garmin, the Garmin logo and the Garmin delta are trademarks of Garrnin l td. or its subsidiaries and are registered in one or more countries, iocluding the U.S. The Authentic Garmin Attessory logo and connext are trademarks of Garmin ltd. or its subsidiaries.

007-01703-01 Rev. B 170-00871·01

. L Appro, ·ing cori1~ __ nt AuthOJi ty Cotmuy

A ntmitl} Camp(ifl.'trli.!•PllJ -s

4.

DIRECTION GENERALE DE L'AVIATION CIVILE

FRANCE

Organisation Name and Address :

2.

)I I

AUTHORISED RELEASE CERTIFICATE

~ .. A Cett~A~~·Ft~~u~risO G ~ ~ '· Formulaire 1 de I'EASA {., b ~ ~\ '

3 . Form\ king Number N" de repere du Formulaire

20 I 430 I NKE IN I B

~ 11111111111111111111111111111111111111111111111111

5 . Work Order I Contract / Invoice Nom et Adresse de I'Organisme: .I Uli':l# !II 'I

MICHELIN - LPA}' Place des Carmes-q echaux

Bon de commande I Contra!. I Facture

A ' . . •. . •

6 . Item/Item 7. Description I Description

NIA 18X5.5181190

63040 CLERMONT-FERRAND CEDEX 9 FRANCE

8. Part No./ N• de piece 9. Oty t Qte

028-630-0

1111111111111111111111111111111 11111111111111111111111

9358S00201

10. Serial No. I N• serie 11 . Status I Work I Etat I Travaux

9358S00201

11111111111111111 11111111111111111111111

NEW

12. Remarks Remarques

'This document has been issued according to an approved computer generated signature procedure· Norme(s) : ETSOC62d, TSOC62e f ·ce document a ete emis selon une procedure approuvee de signature electronique·

ETSOC62d Approval Number: EASA.210.887, TSOC62e LODA Approval Number: Tli'/sn/8/14/2008-427

13a Certifies that the items identified above were manufactured in conformity to : Certifie que les elements identifies ci-dessus ont ete fabriques conformement aux :

li!l approved design data and are in a condition for safe operation

14a. D Part145 .. ORelea setoService Appr- ation pour remise en service SeJ n Partie 145.A.50

D Other regulatio_!Y-fpecified in block 12 Autre reglep(entation precisee en case 12

donnees de conception approuvees et sont en etat de fonctionner en toute securite lhat unless otherwise specified in block 12. the work id tified in block 11 and described in block D non-approved design data specified in block 12 as accompli shed in accordance with Part 145 and in pect to that work the items are considered

donnees de conception non approuvees specifiees dans Ia case 12 ady for release to serv ice. Certifie que, sauf indication contraire specifiee case 12, les travaux identifies en case 11 et decrits en case 12 ont ete realises conform · nt a Ia partie 145 et qu'au vu de ces travaux, les

13b. Authorised Signature Signature autorisee

13d. Name I Nom

13c. Approval/Authorisation Number Numero d'agrementld'autorisation

FR.21 G.01 00

I Aulhor!red 11 13e. Date (dd mmm YYYY) I Date (jj mmm aaaa)

06 Jan 2020

USER/INSTALLER RESPONSIBILITIES I Responsabilites de /'utilisateurl instal/ateur This certificate does not automatically const~ute author~ to install the ~em( s ). Ce document ne constitue pas forcement l'autorisatlon d'instalter l'(es) item(s)

pieces sont considerees pretes a Ia remise


14d. Name I Nom

14c. Certificate/Approval Ref. No N° du Certificat/Agrement

14e. Date (dd mmm yyyy)/ Dat•

Where the user/installer performs work in accordance ~h regulations of an airworthiness author~y different than thelairworthiness authority specified in block 1 it is essential that the user/installer ensures that his/her airworthiness author~y accepts ~ems from the airworthiness author~ specified in block 1. Quand /'utilisateurl instal/ateur travaille selon /es reglementations d'une autorite de navigabilite differente de l 'autorite de navigabilite mentionnee dans Ia case 1, II est essentiel que /'utilisateurl installateur s'assure que son autorite de navigabilite accepte les items liberes par /'autorite de navigabilite mentionnee dans Ia case 1.

Statements in blocks 13a and 14a do not const~ute installation certification. In all cases aircraft maintenance records must contain an installation certification issued in accordance ~h the national regulations by the user/installer before the aircraft may be flown. Les indications ponees en cases 13a et 14a ne constituent pas une certification de montage. Dans tousles cas le dossier d'entretien de /'aeronef dolt contenlr une certification d' lnstallation delivree conformement aux realements nationaux par /'utilisateurl lnstal/ateur avant aue /'aeronef puisse voler.

EASA Form 1 Issue 2 I Formulaire 1 de /'EASA Edition 2

I

L Appro,·ing competent Auth01ity COlmny

Autmitf 01111plifJ.'III<~Pays

4.

DIRECTION GENERALE DE L'AVIATION CIVILE

FRANCE

Organisation Name and Address :

2.

AUTHORI~~!!c~~;~~~~u~;~TIFICA T: oK EASA Fd>RM ·1 L-D6 l7-' 4. Formulaire 1 ye J'EASA y/1\(i£ 3-:p

MICHELIN ..:. LP

3. Form \ .<ing Number N• de repere du Formulaire

20 I 421 I NKE IN I B

1111111111111111 1111111 1111111 1 111111111111 11~111 111 1 ~1~11111 5. Work Order I Contract / Invoice

Nom et Adresse de I'Organisme : IS.~Y'¥<??!t, ,, Place des Carmes-Qechaux Bon de commande I Cont:Jat I Facture

63040 CLERMONT ~fER RAND CEDEX 9 9358S00196

FRANCE

6. Item /Item 7. Description I Description 8. Part No. IN" de piece Oty 1 Qte 10. Serial No. I N• serie 11 . Status I Work/ Etatl Travaux

028-630-0 9358S00196

NIA 18X5.5181190 111111111111111111111111111111111111111111111111111111

1 11111111111111111 11111111111111 111111111

NEW

I 12. Remarks "This document has been issued according to an approved computer generated signature procedure·

.· Remarques Norme(s) : ETSOC62d, TSOC62e ·ce document a ete emis selon une procedure approuvee de signature electronique·

ETSOC62d Approval Number: EASA.210.887, TSOC62e LODA Approval Number: TF/sn/8/14/2008-427

13a ·cer.tifies that the items identified above were manufactured in conformity to : Certifie que les elements identifies ci-dessus ont ete fabriques conformement aux :

Part 145. . 0 Release to Service D Other regulatio]Y-fpecified in block 12 Autre reg/epfentation precisee en case 12

ll!l approved design data and are in a condition for safe operation donnees de conception approuvees et sont en etat de fonctionner en toute securite

D non-approved design data specified in block 12 donnees de conception non approuvees specifiees dans Ia case 12

Appt' ation pour remise en service ~ n Partie 14S.A.50

Certifi~hat unless otherwise specified in block 12. the work id ti:ed in block 11 and described in block as accompli shed in accordance with Part 145 and in r pect to that work the items are considered

ady for release to service. Certifie que, sauf indication contraire specifiee case 12, les travaux identifies en case 11 et decrits en case 12 ont ete realises conforme nt a Ia partie 145 et qu'au vu de ces travaux, les


13c. Approval/Authorisation Number Numero d'agrementld'autorisation

FR.21G.0100

pieces sont considerees pretes a Ia remise en service.


14c. Certificate/Approval Ref. No N• du Certificat!Agrement

13d. Name / Nom 14d. Name I Nom

~N··-~i:, ~D ~=-1 QAt!fd~- N01ll ~---------~------t---------T:.__------+-------------:r':::._---Aulhori:r:ed 13e. Date (dd mmm yyyy) I Date (jj mmm aaaa) 14e. Date (dd mmm yyyy)/ Dat•

06 Jan 2020

USER/INSTALLER RESPONSIBILITIES I Responsabilites de /'utilisateurlinstallateur This certificate does not automatically constitute authority to install the item(s). Ce document ne constitue pas forcement l'autorisation d 'installer l'(es) item(s)

Where the user/installer performs work in accordance with regulations of an airworthiness authority different than the airWorthiness authority specified in block 1 it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority specified in block 1. I

Quand /'utilisateurl installateur travaille seton /es reglementations d'une autorite de navigabilite differente de l'autorite de navigabilite mentionnee dans Ia case 1, il est essentiel que /'utilisateurl installateur s'assure que son autorite de navigabilite accepte les items liberes par /'autorite de navigabilite mentionnee dans Ia case 1.

Statements in blocks 13a and 14a do not constitute installation certification. In all cases aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown. Les indications portees en cases 13a et 14a ne constituent pas une certification de montage. Dans tousles cas le dossier d'entretien de /'aeronef dolt contenir une certification d'installation delivree conformement aux realements nationaux oar l'utilisateurl instal/ateur avant aue l'aeronef ouisse voler. ·

EASA Form 1 Issue 2/ Formulaire 1 de I'EASA Edition 2

I

+ I I I ! ' i

( ( 1. Approving Civil Avlei/Of1 2. . 3. Form Tracking Numbor;

Alilhority/Country:

AUTHORIZED RELEASE CERTIFICATE FAA/United States 1237157 FAA Form 8130·3 AIRWORTHINESS ARPROVAL TAG

4.. Org2nlzaUon Nama and Address: !1. Work Drdor/Contractllnvo/ce Number: AVOX SYSTEMS INC. PQOGIIONE 794396 225 Erie Street m73o L.ancaster,New York 1401Sll

--- ----- ----- - -·----- ---- -· ~- ----~---·-· ... -~--- ---------·-- - - .. -- . -.... Pack : 1237167 ·-·· -----··

8.1!em: 7. Deserlpt!on: s. Part Number: 9. Quantlty: 10. Serial Number: 11. Stalus/Work:

(1) DISC. SNAP SUB ASSY 171-10 100EA N/A NEW

I

I

I 12. Romar/<5: DRAWING REV/EO : (1) FO

MANUFACT.-TEST DATE: (1) DEC2011

THIS AIRWORTHINESS APPROVAL TAG APPLIES TO ASSEMBLIES AND/OR COMPONENT PARTS OF ASSEMBLIES OF FAA APPROVED PRODUCTS. THE 'AVOX sYSTEMS FAA

APPROVED PARTS LIST' IS AVAILABLE AT WNW.AVOXSYS.COM, CUSTOMER SUPPORT, PRODUCT APPROVALS OR BY CALLING 1-71 S-003-5100. THE PART(S) SHIPPED UNDER

n-IlS APPROVAL MAY BE A SUBCOMPONENT OF AN FAA APPROVED ASSEMBLY OR ASSEMBLIES. INFOR'-'.A110N REGARDING THE PMA AUTHORIZATION PART/APPLIANCE HIGHER

ASSEMBLY PART NUMBER CAN BE FOUND AT THE AI/OX WEBSITE. THIS PMA PART IS NOT A CRITICAL COMPONENT.

13o. Certlfles 111e Item• Identified above were manuractured In conformity to :

~~ [KJ Approved design data and are In a condition for safe operation. lock 12, the"""" ldon!lfled In 1 end described

0 Non-approwd design data specified In Block 12. • with Tlfto 14, Codo enol Rogulo!lone, part 43 pmved for f"' aarvlcw.

13b. Authorized Signature ; 1Jc. Appro onl'o.: 14b. Aulhorlud5ign.W~ 1o4c. Approvai/Cortilk;ato No.:

~~q~c.- 11733n883 ~ 13d. N~~tne: (Typed or Printed): 13&. uate (Gdlmmnvyyyyj: ~rPrlnh>d): 14t. Dahl (dd/mm ••.: ,.,.

--=----Brenda Rice 03/JAN/2018

user/Installer KesponsiDIIItles

1 It Is Important to understand that the existence ol this document elone does not autometlcally conothuUI IIU!horlty 10 lnst./1 the elrcrnllenglne/propelledartlcle.

Where the u!!erllnstatler perfonns work In accordance wilh lho national regulations ol an elrw<lfll1lneN authority cmt.nlnt than tho alrworthlnesl authority ollhe country speciHed In Block 1. It Is essential that tho ""erllnatoUor ensures that hlslhor alrwor!hlnooo authority accepts aln;raft englne(o;.'propollorjs)lart!cle(s) from the a/rWOrthlneoo olllhorlty ollhe coun!Jy specified In Block 1.

Statements ln Bloclcs 13a and 14a do not constltutG Installation cerUffcatlon. In all caSCts. aircraft ma\ntanance rKOrds must contain an JnstaUatlon eer11ftc:atlon Issued In acconfanc.e with the national r•gulatlons by the userllnstaller belore the aircraft may be flown. . ... ,.., .. .......... ~ ................... -

·' S<gnalure:

-Lo6~--flrfpG-.

3lf

~

0 r--. "<t

(/)

>I-

b a.. 0

C\1

>.

0 <D C\1 CD CD "<t

l{} <D (") r--.

0

Q) c

:.:J

~

l{} (") C\1 l{} C\1 (]) 0 0 CD

,ji .Q. .c (/)

0 C\1 0 £:! 0 !2

>a.. 0 0 0 w u::: f= a: w 0 w :::> a: t-

c.i c

c 0 .5 .a ·;::::

tl 0 0) c ·a; 0 ill

1. Approving Civil Aviation Authority/Country:

2.

AUTHORIZED RELEASE CERTIFICATE

( 3. Form Tracking Number

1103806

FAA/UNITED STATES FAAFonn81 AIRWORTiiiNESS APPROVAL TAG 4. Organization Name and Address: 5. Work Order/Contract/Invoice

Number: 1103806 Williams International 2000 Cente Ml48341 FAA Station WI5R335J

6. Item: I 7. Description: 8. Part Number: 9. Quantity:

12. Remarks

FJ33-5A, Check 2 Line Maintenance Kit

126280

The Williams International Repair Station has inspected articles in accordance with: FJ33-5A Line Maintenance Manual, Revision 18. SL44-71-225, Revision 5 QTY PN DESC QTY PN 1 110931 FUEL NOZZLE ADAPTER 1 224872 1 110930 FUEL NOZZLE 2 67908 IGNITER 1 119281 OILFILTER 1 120901 FUEL FILTER 1 61752 NUT 1 61411 FUELNOZZLESEAL Parts identified in block 12 are contents for one kit. Total Hours: N/A Total Cycles: N/A

10

DESC 0-RING KIT

10. Serial Number:

N/A

11. Status/Work:

INSPECTED

L.-0&/3001=f~trPG 3<f

Certifies that the work specified in Block 11/12 was carried out in accordance with EASA Part 145 and in respect to that work the articles are ready for release to service under EASA Part 145 Approval Number: EASA.145.5019.

It is important to understand that the existence

[8l 14 CFR 43.9 Return to Service 1:81 Other regulation specified in Block 12

Certifies that unless otherwise specified in Block 12, the work identified in Block 11 and described in Block 12 was accomplished in accordance with Title 14, Code of Federal Regulations, Part 43 and in respect to that work, the items are approved for return to service.

14c. Approval/Certificate No.: WI5R335J

14e.

to install the aircraft engine/propeller/article.

Where the user/installer performs work in accordance w ith the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in Block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts aircraft engine(s) I propeller(s) I article(s) from the airworthiness authority of the country specified in Block 1.

Statements in Blocks 13a and 14a do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.

FAA Form 8130-3 (02-14) NSN: 0052-00-012-9005

Documents

~CIRRUS ~AIRCRAFT