PRINT PAGE 1 PRIVACY ACT STATEMENT OMB Cntrl Number 2120-0729 Expires 2/29/2012 Paperwrk Reductin Act Statement: The infrmatin cllected n this frm is necessary t btain aircraft re-registratin. We estimate that it will take apprximately 30 minutes t cmplete the frm. Please nte that any agency may nt cnduct r spnsr, and a persn is nt required t respnd t, a cllectin f infrmatin unless it displays a valid OMB cntrl number. Frm Apprved, OMB N. 2120-0729 "Cmments cncerning the accuracy f this burden and suggestins fr reducing the burden shuld be directed t the FAA at: 800 Independence Avenue SW, Washingtn, DC 20591. ATTN: Infrmatin Cllectin Clearance Officer, AES-200' DEPARTMENT OF TRANSPORTATION-FEDERAL AVIATION ADMINISTRATION AIRCRAFT RE-REGISTRATION APPLICATION AIRCRAFT REGISTRATION NUMBER N 606RN SERIAL NUMBER MANUFACTURER MODEL RAYTHEON COBRA DATE OF ISSUANCE DATE OF EXPIRATION TYPE OF REGISTRATION NAME AND MAILING ADDRESS OF REGISTERED OWNER (If individual, give last name, first name and middle initial) (Owner 1) RAYTHEON CO. (Owner 2) Nte: Enter any additinal wner names n page tw f this dcument. (Address) P.O. BOX 11337 (Address) 006 City TUCSON State AZ_ zip 85734-1337 Cuntry USA PHYSICAL ADDRESS (REQUIRED WHEN MAILING ADDRESS IS A P.O. BOX OR MAIL DROP) (Address) BLDG M09. MS 6 (Address) 1151 E. HERMANS RD. City TUCSON State AZ_ zip 85706-9367 Cuntry USA FAILURE TO RE-REGISTER WILL RESULT IN CANCELLATION OF REGISTRATION AND REGISTRATION NUMBER ASSIGNMENT (See 14 C.F.R. 47.15(i), 47.40 and47.41) CORPORATION INFORMATION FOR COMPLETION Additinal infrmatin may be btained at ur web page http://registrv.faa.gv/renewreaistratin r by phne at 866-762-9434. Aircraft Registratin Infrmatin may be reviewed at : http://registrv.faa.gv/aircraftinguirv Please pay fees with a check r mney rder payable t the Federal Aviatin Administratin. Signature Requirements fr Listed Registratin Types: Individual wner must sign. Partnership a general partner must sign. Crpratin a crprate fficer r managing fficial must sign. Limited Liability C. a member, manager, r fficer wh is authrized t manage the LLC must sign. C-wner each c-wner must sign, cntinuing as necessary, n page number tw. - Gvernment any authrized persn may sign. Nte: All signatures must be in ink. > 0 (t T3 P+ <D a <d CO w TO RE-REGISTER AIRCRAFT: REVIEW REGISTRATION INFORMATION, ENTER CORRECTIONS IN BLANKS PROVIDED, CHECK APPLICABLE BLOCK BELOW, SIGN, DATE, & MAIL WITH THE $5 FEE, T: The FAA Aircraft Registratin Branch, PO Bx 25504, Oklahma City, OK, 73125-0504. 0 I (WE) CERTIFY THE: NAME(S) AND MAILING ADDRESS SHOWN ABOVE FOR THE OWNER(S) OF THIS AIRCRAFT ARE CORRECT, OWNERSHIP MEETS CITIZENSHIP REQUIREMENTS OF 14 CFR 47.3, AIRCRAFT IS NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. UPDATE THE MAILING / 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 REQUIREMENTS OF 14 CFR 47.3, AIRCRAFT IS NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. TO CANCEL THE REGISTRATION FOR THIS AIRCRAFT: THE LAST REGISTERED OWNER MUST: MARK THE APPLICABLE BLOCK(S), COMPLETE, SIGN, DATE & Mail with any fees t: The FAA Aircraft Registratin Branch, PO Bx 25504, Oklahma City, OK, 73125-0504. CANCELLATION OF REGISTRATION IS REQUESTED FOR THE REASON MARKED BELOW, 1. THE AIRCRAFT WAS SOLD TO: (Shw purchaser's name and address) MAILING ADDRESS 2. THE AIRCRAFT IS DESTROYED OR SCRAPPED. PHYSICAL ADDRESS: COMPLETE IF PHYSICAL ADDRESS HAS CHANGED, OR NEW MAILING ADDRESS IS A PO BOX OR MAIL DROP. BLDG 845, MS 5 1151 E. HERMANS RD. TUCSON, AZ 85706-9367 I 3. THE AIRCRAFT WAS EXPORTED TO: 4. OTHER, Specify UPON CANCELLATION, PLEASE RESERVE THE N-NUMBER IN OWNERS' NAME. The $10 check r mney rder fr the N- number reservatin fee is enclsed. SIGNATUR! PRINTED NAME OF SIGNER TITLE DATE SCOTT L. JONES ASSISTANT SECRETARY 15 NOV 2011 ' PRINTED NAME OF SIGNER TITLE DATE AC Frm 8050-1A (03/11) _ Ji32711Q5546-55. QQ 11/23/2011
FORM APP OMB N. i /ED UNITED,StATES OF AMERICA DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADttMSTRXTION-MKE MONRONEY AERONAUTICAL CENTER AIRCRAFT REGISTRATION APPLICATION - UNITED STATES REGISTRATION NUMBER N (poç ftvi AlgCRAR MANUFACTURER & MODEL AID^DâCreCDIAI ü i Z ' AIRCRAFT SERIAL N. OCKp TYPE OF REGISTRATION (Cheek ne b*) CERT. ISSUE DAT n JUL 1 % 2006 m m Ml FOR FAA USE f^j 1. Individual 2. Partnership q,3. Crpratin 4. C-wner 5. Gvt. 8 -cipssòn NAME OF APPLICANT (Persn(s) shwn n evidence f wnership. If Individual, give last name, first name, and middle initial.) TELEPHONE NUMBER: ADDRESS'(Permanent mailing address fr first applicant listed.) (If P.O. BOX is used, physical address must als be shwn.) Number and street:_ U s I a. t A ^ v r v ^ f t ^ s M. M 5 Rural Rute: CITY STATE P.O. B,: H ± 3 7 ZIP CODE I VAC 5 v > A z. (197 CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS ATTENTION! Read the fllwing statement befre signing this applicatin. This prtin MUST be cmpleted. A false r dishnest answer t any questin in this applicatin may be grunds fr punishment by fine and /r imprisnment (U.S. Cde, Title 18, Sec. 1001). i/we CERTIFY: CERTIFICATION (1) That the abve aircraft is wned by the undersigned applicant, wh is a citizen (including crpratins) f the United States. (Fr vting trust, give name f trustee: CHECK ONE AS APPROPRIATE: a. A resident alien, with alien registratin (Frni 1-151 r Frm 1-551) N.. b. A nn-citizen crpratin rganized and ding business under the laws f (state) _ and said aircraft is based and primarily used in the United States. Recrds r flight hurs are available fr inspectin at (2) Ttiat the aircraft is nt registered under the laws f any freign cuntry; and (3) That legal evidence f wnership is attached r has been filed with the Federal Aviatin Administratin. -), r: NOTE: If executed fr c-wnership all applicants must sign. Use reverse side if necessary. TYPE OR PRINT NAME BELOW SIGNATURE EACH PART OF THIS APPLICATION MUST BE SIGNED IN INK. SIGNATURE ^ ^ ^ J \\cwv-vey s, ÂJCS* TITLE ß/L. SIGNATURE ^ r/j^c s fi 1/icKr^ TITLE» CÙAÂ/U^Ct* 5K ftì/w/) OC H, DATE ^ / t / ö G DATE /ijc.signature TITLE DATE NOTE Pending receipt f the Certificate f Aircraft Registratin, the aircraft may be perated fr a perid nt in excess f 90 days, during which time the PINK cpy f this applicatin must be carried in the aircraft. ' ' i AC Frm 8050-1 (5/03) (0052-00-628-9007)
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Paperwrk Reductin Act Statement: The infrmatin cllected n this frm is necessary t ensure applicant eligibility. The infrmatin is used t determine that the applicant meets the necessary qualificatins as wner f an amateur built aircraft. We estimate that it will take apprximately 30 minutes t cmplete the frm. The infrmatin cllectin is required t btain a benefit. The infrmatin cllected becmes part f the aircraft registratin system. Please nte that an agency may nt cnduct r spnsr, and a persn is nt required t respnd t, a cllectin f infrmatin unless it displays a currently valid OMB cntrl number. OMB 2120-0042. AFFIDAVIT OF OWNERSHIP FOR EXPERIMENTAL AIRCRAFT INCLUDING AMATEUR-BUILT AIRCRAFT AND OTHER NON-TYPE CERTIFICATED AIRCRAFT e JB* U. S. Identificatin Raythen Cmpany - Name f Amateur built builder OR Name f Nn TC'd manufacturer Mdel Cbra Raythen Cmpany Class (airplane, rtrcraft, glider, etc.) Unmanned Airplane Serial Number ; 006 1 1 1 H 8 3 5 Type f Engine Installed (reciprcating, turbprpeller, etc.) Reciprcating Number f Engines Installed 1 Manufacturer, Mdel and Serial Number f each Engine Installed Desert Aircraft, SN DA2184 Built fr Land r Sea Operatin Land Number f Seats (0) Zer MUST CHECK ONE CONVEYANCE DA-150, RECORDED MS JUL 12 API 10? FED RAL AV AT!Q N ADMINISTRATION Mre than 50% f the abve-described aircraft was built frm miscellaneus parts and I am the wner. (This ptin is fr amateur-built aircraft.) Mre than 50% f the abve-described aircraft was built frm a kit (prefabricated parts) and I am the wner. The bill f sale frm the kit manufacturer is attached. (This ptin is fr amateur-built aircraft.) XX I certify that the abve-described aircraft is a newly manufactured nn-type certificated aircraft and is nt currently registered in anther cuntry. (This ptin is fr manufacturers nly.) I certify that the abve-described aircraft is a previusly manufactured (used) nn-type certificated aircraft and is nt currently registered in anther cuntry. Evidence f wnership frm the aircraft manufacturer thrugh any intervening wners is attached. (This ptin is fr wners f previusly manufactured aircraft nly.) Name f Owner: Raythen Cmpany Signature f Owner: A Title f Signer (If Apprpriate): Senir Manager, Cntracts Address 1150KE. Hermans Rad, P.O. Bx 11337 Bldg. M09, Mail Statin 5 City: Tucsn State: AZ Zip: 85734-1337 Telephne: 520-545-9969 Ntary Public: State f: Arizna Cunty f: Pima Subscribed and swrn t befre me this 2 * day f ZOO fr My Cmmissin Expires: Ub/Ul/ZUU9 06/01/2009 (Signature f Ntary Public) CAROL M. GAUDETTE AC Frm 8050-88 (10/05) ROTARY PUBLIC- ARIZONA PtMACOUNTY ' My Cmm. Exp : Jute 1,2009 ù S / i / ^ a Z T
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