EFTA00075689.pdf

UNITED STATES OF AMERICA - DEPARTMENT OF TRANSPORTATION PPM! AVIATION ADMINISTRATOR - MIKE MONRONEY AERONAUTICAL CENTER AIRCRAFT REGISTRATION APPLICATION 1 0 UNITED STAS REGISTRATIO TEN N 722JE ° i hitt TYRE OF O a Penenhp HUMBER REGISTRATION O 3. corprom NRCRAFT NANUFACTUREM MD NOM. Sikorsky S-76C °O 54 Co-Ote Gotten, (Chen one bat) 0 ASKRAFT 0 7 LeonUnity Catty (Lit) sena/ 760750 a a Non-Otton Carport., o) NUMBER O 9 NonGeteen Canton CoOner NAILS) OF NVIJGAMT(S) (Penon(e) not on wets or/ oaten I rental, doe Ind an fi t fat we fate feel -Hyperion hi r L-1-t TELEPHONE NUMBER ( -4149. ) PAPoR"PaR IMAM ADDRESS (Pentrit tang antera ice En Naomi NUNDER ANO STREET. "^ " "n• - as I RURAL ROUTE. P O. BOX CRY -.tattyest STATE ZIP Meets PHYSICAL ACCRESSA.00ATION 0 BO NUNBER AND STREET DESCRIPTION Of LOCATION CITY STATE- VP • CHECK HEREIF YOU ARE Jakr REPORTING A CHANGE OF ADDRESS CERTIFICATION AVE CURVY. (1) The Pe tee nth a tned by to t.4. .n websa no re Mar CIIEGR ARMOR ODIEFIETE Alf nate Ei • Ad/:tendon Urine St endered by 49 USC 40102(15L . m A tents a nth SCSI tett (Ion, 1-S51) No. El o A not®, oaten aµrved and amp buskin* air the nos of (to) it sad acre to Need at Fatty tents Weed Shit Records al Met hoes are -ranee lot rano et (amid mann Ott admen O' A =paten nen it very tnat to cyfelty Enter rein d Inane (2) Mt c or d dawn a deli I. Pe toe aced. feel the I an IfeeNted bfeetePlea Sea nealf to FRo oolaa da r n a t° seek tral rezIstton a bN cI re art and tient pint the ere at,..t tonere:nett (9) Ted te noel b on reganned at Ihe ban of a Baer ate)- and (4) Thor let emote d senate le ended or has been reek elh the Feat Ante innantnew MR MID ALL SICIPIATORIES OF THIS APPLICATION MUST READ THE FOIIONING ARO ISICIMSTAND THAT BY APPLYING A SIGRAIURE TO TIOS DOCUMENT, THEY ARE SUBJECT TO THE REFEIZENCED STATUTES AND ASSOCIATED PENALTIES- I hereby cetera Out the alternator proofed hen) ard ri any roadrrerds to the apphsetran to amid rugs:maw e true, accurffie Mid Mena SI St be dm inaladpe ad bad I uncersand ON to r derMAW proveled by rne el be 'ad al by to FM ateristrator is rasher *terraces a/ walker= for own regeirston I urdersard that Weser to arry meter otos the prothaton of any departnara a mercy d the Uneed Satre, burg* and es terries, core:etas a oseers up (by airy rick scheme a drew) a rnatmel la:torero makes wry tease. rrteleaang a Iraudtant sib Cr I up.us rt.:icos or entry, nary Ire ford up to 3250000 or minsorof net rue den fee (5) years ar beds (18 U S C Smarts 1001 aid 3571) I =Sots-% tat. should orestenally pollee ay meats a tube eauear .. regershan of to sand satin may be revoked NOTE 11 <aoudad tar , all applicants must sign. Use mod page and add pagers) it necessary. SIGNATURE: , DATE: ( .0_. 1/.1 Ei 1 TYPED/PRINTED *WE: Lawrence P. Visoski, R. TIRE. µ any SIGNATURE: DATE 2 TYPED/PRWTED HARE TITLE- 1107£ Except when the most recent nredstrabon el the sae abode is expired of amcensd, 14 CFR 47 31(c)rides for an airworthy U.S. arra to to operated for up to 93 drys within the WWII States when a copy of the %grad application for Its mistrytkei mated in the draelt rs eyeing Issuance and receipt at the row registrstion cortalta. AC Form ao50.1 (1019) EFTA00075689 EFTA00075690 FILED -WITH FAA AIRCRAFT REGISTRATION BR 1014 JUN I 3 AN 12 OKLAHOMA CITY , OKLAHOMA OocuSign Envelope ID: 7C21388F-7DCCA,O6B-9CC1-7C830CC9F594 O FORM APPROVED O OMB NO. 2120-0042 UNITED STATES OF AMERICA 0 U. S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION 0 AIRCRAFT BILL OF SALE FOR AND IN CONSIDERATION OF $ THE UNDERSIGNED OWNER(S) OF THE FULL LEGAL AND BENEFICIAL TITLE OF THE AIRCRAFT DES- CRIBED AS FOLLOWS: 0 UNITED STATES 0 REGISTRATION NUMBER: N722JE a0 AIRCRAFT MANUFACTURER & MODEL Keystone (Sikorsky) model S-76C O AIRCRAFT SERIAL NO. 760750 O CO DOES THIS l3 DAY OF June, 2019, 0 HEREBY SELL, GRANT, TRANSFER AND (.4 DELIVER ALL RIGHTS, TITLE, AND INTERESTS Do Not Witte In This Block IN AND TO SUCH AIRCRAFT • UNTO: FOR FAA USE ONLY NAME AND ADDRESS PURCHASER (IF INDIVIDUAL (S). GIVE LAST NAME. FIRST NAME. AND MIDDLE INITIAL ) Milli m. DEALER CERTIFICATE NUMBER AND TO ITS SUCCESSORS, EXECUTORS, ADMINISTRATORS, AND ASSIGNS TO HAVE AND TO HOLD SINGULARLY THE SAID AIRCRAFT FOREVER, AND WARRANTS THE TITLE THEREOF. IN TESTIMONY WHEREOF, THE UNDERSIGNED HAS SET ITS HAND THIS t3 DAY OF "SLASA- 2019. NAME(S) OF SELLER SIGNATURE(S) TITLE (TYPED OR PRINTED) (IN BLUE INK) (IF EXECUTED (TYPED OR PRINTED) FOR CO-OWNERSHIP, ALL MUST SIGN) SELLER ASI WINGS LLC Senior Vice President, by: a,,t DocuSigned By: Aetna Inc., its Managing controller & Chief Member Ejo.skt-S Accounting Officer ?IC 7.OO072EMSI James D. Clark ACKNOWLEDGEMENT (NOT REQUIRED FOR PURPOSES OF FAA RECORDING: HOWEVER, MAY BE REQUIRED BY LOCAL LAW FOR VALIDITY OF THE INSTRUMENT.) ORIGINAL: TO FAA AC Form 8050-2 (9/92) (NSN 0052.00-629.0003) Supersedes Previous Edition • and the following described engines: TURBOMECA model ARRIEL 2S2 bearing manufacturers serial numbers 42285 and 42286. 191641014476 ADMIN 35381002v1 55.00 06/13/2019 EFTA00075691 EFTA00075692 FILED WITH FAA AIRCRAFT REGISTRATION BR 1019 JUN 13 AU 10: 12 OKLAHOMA CITY OKLAHOMA  OMB Control Number 21204729 apices 0480/17 Paperwork Reduction Act Statement: The information collected on this form is necessary to maintain aircraft registration. We estimate that it will take approximately 30 minutes to complete the form. Please note that an agency may not conduct or sponsor, and a person is not requited to respond to. a collection of information unless it displays a valid OMB control number. Form Approved, OMB No. 2120,0774 'Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Avenue SW. Washington. DC 20591. ATTN: Information Collection Clearance Officer. AES-200.' FAILURE 7O RENEW REGISTRATION WILL DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION FtESULT W CANCELLADON OF REGISTRATION AIRCRAFT REGISTRATION RENEWAL APPLICATION AND REGISTRATION NUMBER ASSIGNMENT (See Id C.F.R. §§ 47.15(0, 47.40 and 47.49 AIRCRAFT REGISTRATION NUMBER SERIAL NUMBER N 722JE 760750 MANUFACTURER MODEL KEYSTONE HELICOPTER S.76C DATE OF ISSUANCE DATE OF EXPIRATION TYPE OF REGISTRATION 08/16/2011 08/31/2020 CORPORATION ENTER REGISTERED OWNER(S) & ADDRESS FROM FAA FILE HELPFUL INFORMATION (Owner 1) ASI WINGS LLC Review Aircraft Registration File Information for this aircraft at: http://reeistry.faa.ciovfaircrattinquirv. (Owner 2) Hai Enter any additional owner names on page two. Assistance may be obtained at our web page: http:/freclistry.faa.qOWrenewreqiStratiOn (Address) bye-mad at: (Address) by telephone at:: City State a Zip When mailing fees, please use a check or money order made Country UtorEo STATES payable to the Federal Aviation Administration. Physical Address: Required *nen mailing address is a P.O. Box or mai drop. Signature and Title Requirements for Common Registration Types: (Address) - Individual owner must sign, title would be 'owner'. - Pannership general partner signs showing -general partner' as (Address) title. City State Zip - Corporation corporate officer or manager signs, showing lull title. Country - Limited Liability Co authorized member, manager, or officer identified in the LLC organization document signs. showing full title. TO RENEW REGISTRATION: REVIEW aircraft registration information. - each co-owner must sign: showing 'co-owner- as title. SELECT the appropriate statement, fiNTER any change in address in the . Co-ownernment ve authorized person must sign and show their full title. spaces below aritl, pia. a SEND form with the $5 renewal fee to the: Note: All signatures must be In ink, or other permanent media. FAA Aircraft Registry, PO Box 25504. Oklahoma City OK 73125-0504. or To correct entries: Draw a single line through error. Make correct entry in by courier to: 6425 S Denning Rm 118, Oklahoma City OK 73169-6937 remaining space, or complete the form on-line. An application form will be rejected if any entry is covered by correction tape or similarly obscured. i I (WE) CERTIFY: THE NAME(S) AND ADDRESSES FROM THE FAA FILES FOR THE OWNER(S) OF THIS AIRCRAFT ARE CORRECT, OWNERSHIP TO CANCEL THE REGISTRATION FOR THIS AIRCRAFT: MEETS CITIZENSHIP REQUIREMENTS OF 14 CFR §47.3, AIRCRAFT IS CHECK All .8 pplicable block(s) below r.OMPiFTF alath DATE & M611. NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. tli O UPDATE THE MAILING I PHYSICAL ADDRESS AS SHOWN BELOW. I (WE) CERTIFY THE: NAME(S) SHOWN ABOVE FOR THE OWNER(S) OF THIS AIRCRAFT IS CORRECT. OWNERSHIP MEETS THE CITIZENSHIP CANCELLATION OF REGISTRATION IS REQUESTED. REQUIREMENTS OF 14 CFR §47.3. AIRCRAFT IS NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. THE AIRCRAFT WAS SOLD TO: (Shaw purchaser's name and address.) NEW MAILING ADDRESS THE AIRCRAFT IS DESTROYED OR SCRAPPED. NEW PHYSICAL ADDRESS: complete if physical address has changed, or THE AIRCRAFT WAS EXPORTED TO: the new mailing address is a PO Box or Mail Drop. OTHER, Specify PLEASE RESERVE N-NUMBER IN THE OWNER'S NAME AND ADDRESS. The 510 reservation fee is enclosed. SIGNATURE OF OWNER 1 (required field) PRINTED NAME OF SIGNER (required field) TITLE- 111.t., id field) DATE Electroncally Certified by Registered Owners 3/28/2017 SIGNATURE OF OWNER 2 PRINTED NAME OF SIGNER TITLE DATE Use page 2 for additional signatures. Fix paid: $5 (201703281I52554432NB) ..1( • Form 5051 - I B (04:12) EFTA00075693 EFTA00075694  OMB Control Number 2120-0729 apices 04/30/I 7 Note: Twelve (12) owner names may be entered on this page. If you require more, enter the first 12 names and then print this page by pressing the 'Print Page 2' button below. Next click the 'Reset' button to clear the data fields (from page 2 only) to add more names. Repeat action as needed. NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE PRINTED NAME OF SIGNER TITLE NAME OF OWNER DATE SIGNATURE I PRINTED NAME OF SIGNER TITLE AC Form 8050-113 (04/12) REF N-NUM: 122.IE EFTA00075695 EFTA00075696  > DEBEE GILCH RIST g 12 AI I ORNEYS Ed COUNSELORS lb a E6 co August 4, 2014 c 9. O V2 Jana L. Hammer, Manager N o Aircraft Registration Branch t Federal Aviation Administration RE: Executive Jet Management; One (1) Keystone Helicopter S-76C; Serial Number 760750; U.S. Registration Number N722JE; Our File Number: 5502.0015 Dear Ms. Hammer: On behalf of AS1 Wings LLC, as registered owner (or co-owner) of the above described aircraft, we hereby request that a duplicate Certificate of Registration be issued for the above referenced aircraft. The original was inadvertently returned to the FAA for mailing, but the address listed is not the address where the helicopter is located. Please deliver the duplicate Certificate of Registration to the attention of the undersigned in the Public Documents Room. We are enclosing $2.00, in payment for the duplicate certificate fee. Very truly yours, A SrPKA417 Brandt S. Sterling Legal Assistant 142161527019 $2.00 08/04/2014 • Oklahoma City, OK • • Fax: www.debeegilchrist.com EFTA00075697 EFTA00075698 FILED WITH FAA 4IRM%Fr ;.ECISTRATION BR 2014 RUG 4 PITI 3 26 OKLAHOMA CITY OKLAHOMA  S Deparf• Flight Standards Service of Tta-spooation Aircraft Registration Branch, AFS-750 Federal Aviation ress: httpwreglstry.taa.gov Administration Date of Issue: August 4, 2014 ASI WINGS LLC HAND DELIVERED TO 'GIL IN THE PD ROOM T146046 This facsimile must be carried in the Aircraft as a Temporary Certificate of Registration for N722JE KEYSTONE HELICOPTER S-76C Serial 760750 and is valid until Sep 03, 2014. This is not an airworthiness certificate. For airworthiness information, contact the nearest Federal Aviation Administration Flight Standards District Office. Manager, FAA Aircraft Registry, AFS-750 Federal Aviation Administration AFS-750-FAX4 (01/14) EFTA00075699 EFTA00075700  8 V OMB Control Noway 2120.0129 a PRINT PAGE 1 r PRIVACY ACT STATEMENT] a Empires 05.51/2014 m Paperwork Reduction Act Statement: The inl0miali0N COSeCted on the form is necessary to maintain aircraft registration. Wo estimate that it wW lake approximately 30 minutes m to complete the form. Please note that an agency may not conduct or sponsor. and a person is not require() to respond lo. a collection of information unless II displays a wthd L OMB oentroi number. Form Approved. OMB No. 2120-0729 'Comments concerning the accuracy of this burden and suggestions for reducing the burden srbauld be directed to C the FAA M: BOO Independence Avenue SW. Washington. DC 20591. AlTN: Inform:ion Collection Clearance Ottrcer.AES-200.' FAILURE TO RENEW REGISTRATION WILL R.1 DEPARTMENT OF TRANSPORTATION • FEDERAL AVIATION ADMINISTRATION RESULT IN CANCELLATION OF REGISTRATION O AIRCRAFT REGISTRATION RENEWAL APPUCATION AND REGISTRATION NUMBER ASSIGNMENT (See 14 C.F.R. §§ 47.15(9, 47.40 end 47.41) AIRCRAFT REGISTRATION NUMBER SERIAL NUMBER N 722JE 760750 MANUFACTURER MODEL Keystone Helicopter S-76C DATE OF ISSUANCE DATE OF EXPIRATION TYPE OF REGISTRATION August 16.2011 August 31, 2014 Corporation ENTER REGISTERED OWNER(S) & ADDRESS FROM FAA FILE HELPFUL INFORMATION (Owner 1) ASI Wings LLC Review Aircraft Registration Fite Information for this aircraft at: httolireoistry.faa.cov/aircraftinouirV. (Owner 2) Was Enter any additions owner names on page two. Assistance may be obtained at our web page: It 1/re ist yfr never I it ti n (Address) by e-mail at: (Address by telephone al: City State ■ Zip When mailing fees, please use a check or money order made Country payable to the Federal Aviation Administration. Physical Address: Required when mating address is a P.O. Box or mail drop. Signature and Title Requirements for Common Registration Types: • Individual owner must sign, title would be -owner. (Address) Partnership general panne( signs showing 'general partner as Ctle. (Address) Corporation corporate officer or manager signs, showing fun title. City State Zip - Limited Liability Co authorized member, manager, or officer identified In the LLC organization document signs. showing full title. Country • Co-owner each co-owner must sign; showing 'co-owner es title. • Government authorized person must sign and show their rue title. TO RENEW REGISTRATION: REVIEW aircraft registration information. Note: All signatures must be in Ink, or other permanent media. SELECT the appropriate statement, FNTER any change in address in the spaces below. M. DATE & SENO form with the $5 renewal fee to the: To correct entries: Draw a single line through error. Make correct entry in FAA Aircraft Registry, PO Box 25504, Oklahoma City OK 73125-0504, or remain'Ag space, or complete the form on-iine. An application form will be by courier to: 6425 S Denning Room 118, Oklahoma City OK 73169.6937 rejected If any entry is covered by correction tape or similarly obscured. a I (WE) CERTIFY, THE NAME(S) AND ADDRESSES FROM THE FM FILES FOR THE OWNER(S) OF THIS AIRCRAFT ARE CORRECT, OWNERSHIP TO CANCEL THE REGISTRATION FOR THIS AIRCRAFT: MEETS CITIZENSHIP REQUIREMENTS OF 14 CFR S47.3. AIRCRAFT IS gifEcK 011 applicable Necks below, COMPLETE, $1o. DATE a tag. this NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. loan with any fees to the: FAA Aircraft Registry. PO Box 25504, Oklahoma City, OK, 73125-0504, or by courier to: El UPDATE THE MAILING I PHYSICAL. ADDRESS AS SHOWN BELOW. 6425 S Denning Rm. 118, Oklahoma City OK 73169-6937 I (WE) CERTIFY THE: NAME(S) SHOWN ABOVE FOR THE OWNER(S) OF THIS AIRCRAFT IS CORRECT. OWNERSHIP MEETS THE CITIZENSHIP a CANCELLATION OF REGISTRATION IS REQUESTED. REQUIREMENTS OF 14 CFR S47.3. AIRCRAFT IS NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. ▪ THE AIRCRAFT WAS SOLO TO: (Show purchaser's name and address.) NEW MAILING ADDRESS ❑ THE AIRCRAFT IS DESTROYED OR SCRAPPED. NEW PHYSICAL ADDRESS: complete if physical address has changed, or ❑ THE AIRCRAFT WAS EXPORTED TO: the new mailing address is a PO Box or Mail Drop. OTHER, Specify PLEASE RESERVE N-NUMBER IN THE OWNER'S NAME AND ADDRESS. The $10 reservation tee is enclosed. SIGNATURE OF OWt 1 puked field) PRINTED NAME OF SIGNER linda Westbrook (required field) TITLE (required geld) Ass Mani Capon/Is Sean, 01 Aetna Inc, DATE Minn.( of AS! WINGS. tic SIGNATURE OF OWNER 2 PRINTED NAME OF SIGNER TITLE DATE Use page 2 for additional signatures. AC Form 8050-I B (04/12) EFTA00075701 EFTA00075702 FILED W ITH FAA IIRCF!ar PEGI STRATION 6R NH JUL 14 FYI 11 16 I OKLAHOMA CITY OKLAHOMA  DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE006014974 FFR -1B DOC ID 8018 5/1/14 141211307096 $5 5/1/14 EFTA00075703 EFTA00075704 V S Department Flight Standards Service of Transportation Aircraft Registration Branch. AFS-750 Federal Aviation Administration WEB Address: httpfiregistry.faa.gov December 11, 2012 111 Dear Sirs: An AC Form 8050-64, Assignment of Special Registration Numbers, was issued on September 16, 2011, as authorization to the change the registration number on a KEYSTONE HELICOPTER S-76C aircraft, serial number 760750, from N722JE to special number N162AE. This authorization was good for one year from the form's date of issue. The form was required to be signed and returned to this office within five days after the special registration number was permanently affixed to the aircraft. As of the date of this letter, no completed authorization has been received by this office. This authorization expired on September 16, 2012. Accordingly, the assignment of special registration number N162AE to this aircraft was cancelled on December 11, 2012, and returned to the pool of available N-numbers. You may apply to reserve any available N-number as a special number in your name, or request an available N-number be assigned to an aircraft to change that aircraft's registration number. Information about requesting the reservation or assignment of a special registration number may be viewed on our web site http://registry.faa.gov. If you have any questions, our toll free telephone number i Manager, Aircraft Registration Branch, AFS-750 AFS-750-RE1tEG-14 (09/10) EFTA00075705 EFTA00075706 V S Department Flight Standards Service of Transportation Aircraft Registration Branch. AFS-750 Federal Aviation Administration WEB Address: ettp:firegistry.faa.gov October 12, 2012 ..m...„,nimmilmim Dear Sirs: The FAA Aircraft Registration Branch (Registry) issued an Assignment of Special Registration Numbers, AC Form 8050-64, on September 16, 2011. This form authorized a change of registration number from N722JE to N162AE to be completed within one year of its issue date for the KEYSTONE HELICOPTER S-76C aircraft with serial number 760750. Within five days of placing N162AE on the aircraft a signed copy of this form showing the date of the change was required to be returned to the Registry. The authorization to change registration numbers expired on September 15, 2012, without a completed copy of the form being received by the Registry. We ask that you confirm the status of this registration number change so that the matter may be closed appropriately. If no response is received within 30 days from the date of this letter, the number change will be cancelled and N162AE returned to the pool of available N- numbers. The attached form may be used to confirm the status of this registration number change. If special registration number N162AE has been placed on this aircraft, then upon receipt of your notification, the Registry will update our records and issue a revised registration certificate showing the special registration number. The attached form also may be used to confirm that the N-Number change was not made, to request the reservation of the special number in your name, or to make a new request for N162AE to be assigned as special registration number to change the N-number of this or another aircraft. If we may be of any assistance, our toll free telephone number is Manager, Aircraft Registration Branch, AFS-750 AFS-750-REREG-13 (03/11) EFTA00075707 EFTA00075708 Directions: Select and complete the appropriate section below then send. with the indicated fee (if appropriate). to the FAA Aircraft Registration Branch. U.S. Postal Service. Regular and Priority Mail Commercial Delivery Scn•icc@: FAA Aircraft Registration Branch FAA Aircraft Registration Branch P.O. Box 25504 Registry Building. Rim 118 Oklahoma City. OK 73125-0504 6425 South Denning Oklahoma City, OK 73169-6937 Make fee payment by check or money order payable to the Federal Aviation Administration. For additional information call toll free 1-866-762-9434. or visit hurrfiregistrv.faa.gov FAX No: (405) 954-3548 Dear Aircraft Registry: ❑ Special registration number N162AE. was not painted on KEYSTONE HELICOPTER S-76C serial number 760750. ❑ I/We do not wish to reserve this number at this time. ❑ Please reserve this N162AE in our name. The $10.00 special N-number reservation fee is enclosed. ❑ Please assign N162AE to KEYSTONE S-76C 760750 HELICOPTER (Mate) Maki I Saul Number) for an N-number change. $20.00 is enclosed to cover both the special number request and assignment fees. On ❑ Special registration number N162AE, was placed on KEYSTONE HELICOPTER S-76C serial number 760750 on Luc,. Please issue a revised registration certificate. ❑ The completed and signed Assignment of Special Registration Numbers. AC Fonn 8050-64. is enclosed. ❑ The Assignment of Special Registration Numbers. AC Fonn 8050-64. is lost or destroyed. Please accept this as notice that the authorized N-number change has been completed. Name of Owner: Signature/Title Date AFS-750-REREG-13 (03/11) EFTA00075709 EFTA00075710  ASSIGNMENT OF SPECIAL Special Registration Number N162AE REGISTRATION NUMBERS 0 U.S. Department Aircraft Make and Model Present Registration Number of Transporlation KEYSTONE HELICOPTER S-76C N722JE Federal Aviation Serial Number Issue Date: Administration 760750 Sep 16, 2011 ICAO AIRCRAFT ADDRESS CODE FOR N162AE - 50174441 This is your authority to change the United States registration number on the above described aircraft to the special registration number shown. Carry duplicate of this fonn in the nu I I II II w m aircraft together with the old registration certificate as interim authority to operate the aircraft pending receipt of revised certificate of registration. Obtain a revised certificate of airworthiness from your near- est Flight Standanls District Office The latest FAA Form 8130-6, Application For Airworthiness on file is dated: Dec 08.2008 The airworthiness classification and category: STD TRANSP INSTRUCTIONS: SIGN AND RETURN THE ORIGINAL of this form to the Civil Aviation Registry, AFS-750, within 5 days after the special registration number is placed on the aircraft. A revised certificate will then be issued. The authority to use the special number expires: Sep 16, 2012 CERTIFICATION: I certify that the special registration number was placed RETURN FORM TO: on the aircraft described above. Civil Aviation Re 'sin, AFS-750 Signature of Owner: Title of Owner: Date Placed on Aircraft: AC FORIN 8050-64 (5/2005) Supersedes Pen ion, Edition EFTA00075711 EFTA00075712 LI Insured Aircraft Title Service, Inc. Oklahoma City, Ok Oklahoma City, Ok e-mail address: FAX web site: www.insure airs .com FEDERAL. AVIATION ADMINISTRATION CENTRAL RECORDS DIVISION OKLAHOMA CITY, OKLAHOMA Date: August 26, 2011 Dear Sir/Madam: Please Reserve N in NAME ONLY for: N# Change Request Please Reserve N 162AE• and assign for the following aircraft: N 722JE Make Keystone Helicopter Model S-76C Serial # 760750 Which is (1) being purchased by (2) registered to XX ASI Wings LLC 112381430478 $20.00 08/26/2011 Payment of the required $10.00 fee per number to reserve/assign is attached. If the preferred N number is not available, please contact the undersigned for a selection of a new number. Please send the confirmation of reservation/8050-64 form to Insured Aircraft title Service, Inc. in the Public Documents room of the FAA. Additional Information: • please see attached relinquishment Requested by: Nikala Aun a Jones