EFTA00307677.pdf

FORM APPROVED .?t; 4 -I(I 0141No. 2120-0042 • 41 • • Zi UNITED STATES OF AMERICA DEPARTMENT OF TRANSPO RTATION FaMPALMnadloti AOMMIIMUMON-MIKE MCNINON M Nmostarcet. coma tatcrten REGISTRATION APPLICA11014 REGITatta TATE NuMBER S 722JE AlliCt4ANUFACkIRER 81400EL Keystone (Sikorsky) S-76C NRCPAFT SERIAL Na. 760750 TYPE OF FtEGISTRADON (Check Ono box) O 1. Individual 02. Partnership 't el 3. Corporation 04. Co- S. Co crnt O 8. Non-Cik en Corporal O 8. Non-Citizen -Ow er NAME OR APPUCANT Persen(s) shown on evidence of ownership. It IncsvkluSt Pm I Mme. tint flan". iratial.) ASI Wings, LLC TespiroNEpiumem, ( 860) 273-0386 1410QPCS (Permanent meaty address for fat &Want k 0 O on list) V P. tract also 00 shown) W NW and street- 151 Farmington Ave Rural Route: CITY CODE Hartford 6156 Q CHEC K HERE IF YOU ARE ATTENTION! Read the folio EP *CRANell& j ADDRESS to OrMsignmotnigappScanom This 0 US mpteted. A false or Odhoneet answer to any question in this cation nits for punishment line and/or anon:torment S. upu. YY IN?E CERTIFY'. (1) That the 'stove t. who Is a Citizen (including dons) of of?need t Prelota4eliont'..giventovie I Or. OffeliONE!VS APpROPRIA a. A resident Oen, with or Form 1-551) No „ . b. A nea.catzen Ot"ness undo( the laws of (state) and said that in MO Intel StatearRecords dr light hours are Inspection at WOW.Ice' (z) That the Masa is n ,of any Ian caned': and (31 Tut MON t( 4°.1c hes ern tied with the redeem, Aviation AdmIntstAttion. ship akepplicantsniust sign. Use reverse side it necessary. GNATURE distant Corporate DATE cretary of Aetna Inc *4 gi Member of DAT: ASI Wings, LLC GATE NOTE Pending now the Cert;ficate of Aircraft Registration. thb aircraft may be operated tore period not in excess of 90 demm, during water tme the PINK copy of tens appfleation rntot be carded in the aircraft. AC Form 8050-1 (1/09( (NSN 00524:104128-9007)Supeis ecke Previous Edition EFTA00307677  FORM APPROV OMB No. 2120.00ED 42 IMMO STATES OF AMERICA DE MOW. MARTON PARTMON OF AodeonATION-Do TRANSPORTATION itinoCosioNalf MO AIRCRAFT NONalnicu, cEN TICKAPLIs CAT/ON TII. AEGAWNrAtel alli t ER AlliCRAFTStIUkaC7U N CERT: ATE RER S. . S .-ROC TYPE OF ?Tr AARON (Choc* 01. Individual a0 '. 2.Portant* One boon' On 3. Coiparatfon . 0 Non.aaten Ccdpontti 0 4. 4c NAME CFI APP on 0 9. NonCilizen b LICANT (Pattc410,t hOWIN on tement e of Pomfret*. M re-estdcA4,-, Air-tx4--c IndlAdoef. 9101 . fret name. Imre) of tnc. TEUFPNONETAIME A. IER:. f }' .ACOREbS (Perma nent walling lobos eQ , kit And amarcray on 'dr) (r P. • neat So bet lelO VAL) Nurbor and Soar 103 Fad U2C.. Rural Roulec IDA) CITY F. 7.91 COPE VNI ; i O f t i tit. 0 CHECK HER Oti ARE 113%03 4 ATTENTION! R the folio s EP A thipmer 60 ADORESS . to tore signing this ap . . - ' This p plipation. A *nor dishonest annoy. to US • mpieted. ' to any Weeti011 in lids catwn nit lot pirtehmeof s. 0, 1i.. by Ins OMAN InIC oc 100i). OSOMMet CFMICtL101 1 WIVE CERTIFY: te That the abode Stith Is aimed underAm +ph Is a /Fero 0 (For bating mot, live 999100 900 0,911 name of a1 SATECESITigh.0 " , .":.,4 . ,.... . ..e1P,Id"1. or El or Fi;r4:1-5ily ,,lo, Anon-all:en No. - and sakfaiferah trasineasundor the law s of (state) irtil:OCtiOn at Z,rhuny in the UMW States , ' Rooarda or Ott fittnat maairorrA a Mum so ara ble for of anyIofeiPn and I. ter fi dA. has been ANT Sada Avlation Adi ' ,, .. ..... • renbbeillon. NOT 91. i hip an applicants must sign. Us* reverse side if necessary, TYPE OR E9 GNATURE EACH PART OF tHIS A PPLICATiON MUST MORE. IT , .0.453treS £ ike 4+ KC lets I DATE BE a NATURE t TITLE GATE NOTE Pending receip t of IIACartebbabeo f Nicraft Redinstralio Goya. Outing ANNA Wry A the aircraft maybe op .IN PINK owl of Ws iates for a period application must be not in *roses of 90 owned in the Monk AC Pam 9060-t (1/0 9) (NSN 0052.00-928- 9C07) Superset/e s Pte iota EditIon EFTA00307678