UNITED STATES OF AMERICA - DEPARTMENT OF TRANSPORTATION
FFTPRAI AVIATION ADMINISTRATOR - MIKE MONRONEY AERONAUTICAL CENTER
AIRCRAFT REGISTRATION APPLICATION
1
LINOS) STATES
REGISTRATION N 722JE ° 1 InINNS 0
TYRE OF a a PsWorm
HUMBER REGISTRATION O 3. corprom
NRCRAFT
°4 Co-Oryy
RANUFACTURER
AND NOM.
Sikorsky S-76C O 5 Go.yr.-mon,
(Choy* as bat) 0
0 7 Lurid Uabity Canyon (Lit)
ASKRAF1
sem 760750 O a Non-OUnin Corparalart D
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CITY -ati-voinineai STATE ZIP n IIIIIIMI--___
PHYSICAL ACCRESSA.00ATION
IOW AM) STREET
DESCRIPTION Of
LOCATION
CITY STATE- ZIP
• CHECK HEREIF YOU ARE Jakr REPORTING A CHANGE OF ADDRESS
CERTIFICATION
AVE CEIRTVY.
(1) Thy! Pe rove CA awed by as tryinagred arbra stomataer ClIEGR ARMOR CC/METE AN .. 0
Ei • A Yemen a ale UnInd Seen Is dear by 49 USC 40102(15L
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(4) Red IN* aware al clonsra elocted or has been Med .e, Woe Federal Are Nanrnanexn
ANY MID ALL SICIPIATORIES OF THIS APPLICATION MUST READ THE FOILOINDIO ARO ISICIEItSTAND THAT BY APPLYING
A SIGRAIURE TO DOS DOCUMENT, THEY ARE SUBJECT TO THE REFEIZENCED STATUTES AND ASSOCIATED PEN ALTIES-
I hereby catty that to clormatm proyekil hem archn any atladrrents to the appbabon for naafi rays:mt.:0 a true, accurffie and and to the
be dm inaladpe aid betel I ,,need Oa Me aNirrnaL01proeded by me el be rated at by te FM atatratrator n Maher detennreton of
isaancelon la meal regetraton I urderslird Mai raver, marry manes aim tie prischaton of any departnant a mesa of to UnCed Sates,
buena* and %arty tisane, came& a oilmen up (by any tick scheme a deice) a mama' tact or eft makes any tease, rntileatbrip a handy:Ent
sods an up. ass Luanne or entry, rray balled up 0)3250000 or martsonel not rime ten Ina (5) yeas or bolt (18 USCSectcre 1001 aid
3571) I irdersend that should realticnally p-onde any nocasnate alike ernann.. regelyaban of tie nand emit may bo revoked
NOTE a aoudad ail andkants must sign. Use next page and add pagers) it necessary.
,
SIGNATURE: DATE: (0_ il l- i 111
1
TYPED/PRINTED
Lawrence P. Visoski..1r. TIRE Manager
NAME:
SIGNATURE: DATE
2
TYPED/PRINTED
MU -
NAME
1107£ Except at., the most newt narlstrabri of the sictiNet abash S expired of amcaleck 14 CFR 47 31(c) rides for en .heat,
Masa to te operated for up to 93 drys ran the United States when a cow of the tared applkstIon for IS mien/km S casrkd N the tbtrell
while inning Issuance and roosts at the my ragistrrion mei:a
AC Form Kcal none)
EFTA00150965
EFTA00150966
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 )
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
EFTA00150967
EFTA00150968
FILED WITH FAA
AIRCRAFT
REGISTRATION BR
1019 JUN 13 AU 10: 12
OKLAHOMA CITY
OKLAHOMA
OMB Control Number 21204729
apices 04/30/17
Paperwork Reduction Act Statement: The information collected on this lam is necessary to maintain aircraft registration. We estimate that 4 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 cOrection 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 W CANCELLATION 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.cmyfaircraftinouirv.
(Owner 2)
1' fl Enter any additional owner names on page two. Assistance may be obtained
(Address) at our web page: htID:HreCliSIFV.faa.CIDWrefleWregiStratiOn
by e-mail at: taa.aircraftreoistrvefaa.ciov. or
(Address) by telephone at:: (866) 762 - 9434 (toll free), or (405) 954 - 3116
City State Zip
When mailing tees, please use a check or money order made
Country UNITED STATES payable to the Federal Aviation Administration.
Physical Address: Required viten 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 full 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. - Co-owner each co-owner must sign: showing *co.owner" as brie.
- Government authorized person must sign and show their full title.
SELECT the appropriate statement, f ,NTER any change in address in the
spaces below SIGN.DATE. & auji
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 947.3. AIRCRAFT IS CHECK All applicable bloats) below. cOMPIFTF SIGN_ MIES MIL
NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. this form with any fees to me: FM Aircraft Registry.
PO Box 25504, Oklahoma City, OK, 73125-0504, or by courier to:
O UPDATE THE MAILING I PHYSICAL ADDRESS AS SHOWN BELOW.
I (WE) CERTIFY THE: NAME(S) SHOWN ABOVE FOR THE OWNER(S) OF
6425 S Denning Rm. 118, Oklahoma City OK 73169-6937
THIS AIRCRAFT IS CORRECT. OWNERSHIP MEETS THE CITIZENSHIP CANCELLATION OF REGISTRATION IS REQUESTED.
REQUIREMENTS OF 14 CFR 947.3. AIRCRAFT IS NOT REGISTERED
UNDER THE LAWS OF ANY FOREIGN COUNTRY. THE AIRCRAFT WAS SOLD 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 a Mall 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., I'd 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.
Fee paid: $5 (201703281I52554432NB)
..1( • Form 5051 - B (04)12)
EFTA00150969
EFTA00150970
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
EFTA00150971
EFTA00150972
>
DEBEE GILCH RIST g
V.
ATTORNEYS IR COUNSELORS fb
a
E6
co
August 4, 2014
c
9.
c)
V2
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
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
1421131527019
$2.00 08/04/2014
EFTA00150973
EFTA00150974
FILED WITH FAA
4IRM%Fr ;.ECISTRATION BR
2014 RUG 4 PITI 3 26
OKLAHOMA CITY
OKLAHOMA
S Deparf• Flight Standards Service
of Tia•spooation Aircraft Registration Branch,
AFS-750
Federal Aviation
WEB Address: http://registry.faa.gov
Administration
Date of Issue: August 4, 2014
II l I I I I I... II
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)
EFTA00150975
EFTA00150976
8
V
OMB Contra Numact 2120-0/29 S
PRINT PAGE 1 r PRIVACY ACT STATEMENT] F-xpats 05/31/2014
m
Paperwork Reduction Act Statement: Tne information COSeCted on this form is necessary to maintain aircraft registration. Wo estimate that it ma lake approximately 30 minutes m
to complete the form. Please note that an agency may not conduct or sponsor. and a person is 'Cl required to respond 10. a collection of information unless II displays a valid L
OMB motto) number. Form Approved. OMB No. 2120-0729 'Comments concerning ine accuracy of this burden and suggestions for aoluaina the burden should be directed to C
the FAA at: BOO Independence Avenue SW. Washington. DC 20591. ATTN: Information Collection Clearance Officer. 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 A
(See 14 C.F.R. §§ 47.15(9, 47.40 end 47.41)
AIRCRAFT REGISTRATION NUMBER SERIAL NUMBER
N 722JE 760750
MANUFACTURER MODEL
Keystone Helicooter 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 File Information for this aircraft
at: htto://reoistry.faaoov/aireraftinouifv.
(Owner 2)
Was Enter an additional owner names on o two. Assistance may be obtained
at our web page: htterarechstry laa ativirenearrealaaati0n
(Address)
a-mail at:
(Address) by telephone al: SINIMOMMI
by
City State Zip When mailing fees, please use a check or money order made
Country payable 10 the Fedora; Aviatkin 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 Geo.
(Address) Corporation corporate officer or manager signs, showing full 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 fun title.
TO RENEW REGISTRATION: REVIEW aircraft registration information.
Note: All signatures must be in Ink, or other permanent media.
SELECT the appropriate statement. FRIER any change in address in the
spaces below. WO. 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 remaksase space. or complete the form on-line. 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 §47.3. AIRCRAFT IS gitscK all applicable Mocks below, COMPLETE, Eat!. DATE a may this
NOT REGISTERED UNDER THE LAWS OF ANY FOREIGN COUNTRY. loan with any fees to the: FAA Aireseft 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 §47.3. AIRCRAFT IS NOT REGISTERED
UNDER THE LAWS OF ANY FOREIGN COUNTRY. a THE AIRCRAFT WAS SOLO TO:
(Show purchaser's name end 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
o PLEASE RESERVE N-NUMBER IN THE OWNER'S NAME
AND ADDRESS. The SIO reservation fee is enclosed.
SIGNATURE OF OWt 1 puked field) PRINTED NAME OF SIGNER
Melinda Westbrook
(required field) TITLE (required held)
Ass Man Corporals SoCreNIN 01 Aetna Inc..
DATE
Minn.( of AS! WINGS, LLC
SIGNATURE OF OWNER 2 PRINTED NAME OF SIGNER TITLE DATE
Use page 2 for additional signatures.
AC Form 8050-I B (04/12)
EFTA00150977
EFTA00150978
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
EFTA00150979
EFTA00150980
V S Department Flight Standards Service
of Transportation Aircraft Registration Branch. AFS-750
Federal Aviation
Administration WEB Address: httpfiregistry.faa.gov
December 11, 2012
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 is I
anger, rcra egistranon Branch. AFS-750
AFS-750-RE1tEG-14 (09/10)
EFTA00150981
EFTA00150982
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
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 1
Manager, Aircraft Registration Branch, AFS-750
AFS-750-REREG-13 (03/11)
EFTA00150983
EFTA00150984
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 Sonic:es:
FAA Aircraft Registration Branch FAA Aircraft Registration Branch
Make fee payment by check or money order payable to the Federal Aviation Administration.
For additional information call toll free or visit hurrfirerristrv.faa.aov
FAX No:
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 ,„„„.1„,. 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)
EFTA00150985
EFTA00150986
ASSIGNMENT OF SPECIAL Special Registration Number
N162AE
0
REGISTRATION NUMBERS
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
ASI WINGS I.I.0 aircraft to the special
registration number shown.
Carry duplicate of this form in the
Illmiliiiiiillilikilhillinlimlliiiiiiiiiiiiililiiiiiiii
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 Registry. AFS-750
Signature of Owner:
Title of Owner
Date Placed on Aircraft:
AC FORIN 8050-64 (5/2005) Supersedes Pen ion, Edition
EFTA00150987
EFTA00150988
LI Insured Aircraft Title Service, Inc.
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
Fee: $10.00
EFTA00150989
EFTA00150990
FILED WITH FAA
AIRCRAFT RECISTRATI011 DR
2011 AUG 26 NI 1 56
OKLAHOMA CITY
OKLAHOMA
FORM APPROVED
OMB No. 2120-0042
UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION I
FEDERAL AVIATION ADMINISTRATION-MIKE MONRONEY AERONAUTICAL CENTER 1I
AIRCRAFT REGISTRATION APPLICATION CERT: ISSUE DATE j
i
UNITED STATES
REGISTRATION NUMBER N 722JE i
AIRCRAFT MANUFACTURER & MODEL '
Keystone (Sikorsky) S-76C
AIRCRAFT SERIAL No.
760750 FOR FAA USE ONLY
TYPE OF REGISTRATION (Chock One box) I
i
O1. Individual O 2. Partnership eg 3. Corporation 0 4. Co-Owner 0 5. Government •
O 8. Non-Citizen Corporation O 9. Non-Citizen Corporation Co-Owner
NAME OR APPLICANT (Person(s) shown on evidence of ownership. If individual, give last name, first name, and middle Initial.)
ID ASI Wings, LLC
TELEPHONE NUMBER:
ADDRESS (Permanent mailing address for first applicant on list) (If P.O. Box is used, physical address must also be shown.)
Number and street:
Rural Route: P.O. Box:
CITY STATE ZIP CODE
O CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS
ATTENTION! Read the following statement before signing this application.
This portion MUST be completed.
A false or dishonest answer to any question In this application may be grounds for punishment by fine and/or Imprisonment
(U.S. Code. Title 18. Soc. 1001).
11 1 CERTIFICATION
I/WE CERTIFY:
(1) That the above aircraft is owned by the undersigned applicant, who Is a citizen (Including corporations)
of the United States.
(For voting trust, give name of trustee: ) or:
CHECK ONE AS APPROPRIATE:
a. A resident alien, with alien registration (Form 1-151 or Fonn 1-551) No.
b. A non-citizen corporation organized and doing business under the laws of (state)
and said aircraft is based and primarily used in the United States. Records or flight hours are available for
inspection at
(2) That the aircraft is not registered under the laws of any foreign country: and
(3) That legal evidence of ownership is attached or has been filed with the Federal Aviation Administration.
NOTE: It executed for co-ownership all applicants must sign. Use reverse side it necessary.
TYPE OR PRINT NAME BELOW SIGNATURE
SI NATURE- DATE
Allstant Corporate
EACH PART OF THIS ecretary of Aetna Inc. ,7 -..210- 0
MaAaging Member of DATE
APPLICATION MUST
SIGNA
Melinda Westbrook ASI Wings, LLC
BE SIGNED IN I .
SIGNATURE TITLE DATE
NOTE Pending receipt of the Certificate of Aircraft Regis ration, the aircraft may be operated for a period not in excess of 90
days. during which time the PINK copy of this application must be carried In the aircraft.
AC Form 8050-1 (1/09) (NSN 0052-00-628-9007) Supersedes Previous Edition
EFTA00150991
EFTA00150992
FILED WITH FA A
AIRCR t.FT REGISTRATION BR
2011 JUL 26 811 11 58
OK L A HOP1A CITY
OK I A FCOMA
•
go
0
O
N
a
CO
0
0
3
WARRANTY BILL OF SALE
3
The undersigned, FREEDOM AIR INTERNATIONAL, INC. ("Seller"), is the
owner of the full legal and beneficial title in and to that certain used Keystone (Sikorsky) S-76C
helicopter (sometimes referred to as a S-76C-H-) bearing Manufacturer's Serial No. 760750 and 0
U.S. Registration No. N722JE, with two (2) Turbomcca Arriel 2S2 engines bearing ro
Manufacturer's Serial Nos. 42285 and 42286, together with all avionics, equipment (including a
loose equipment), systems, furnishings and accessories installed on, contained in or attached to
said helicopter and engines, all as is more particularly described in that certain Aircraft Purchase
Agreement dated as of July IR , 2011, between Seller and Purchaser, and also including all
airframe, engine and accessory logbooks, flight and operation manuals, maintenance and
overhaul records, checklists, drawings, any issued FAA Form 337's, warranty documents, and all
other records and paperwork relating to the above-described helicopter and engines in Seller's
possession (collectively, the "Aircraft"); provided, that the term Aircraft as used herein does not
include airframe maintenance manuals and airframe illustrated parts catalogs as the same are being
retained by Seller.
For and in consideration of the sum of Ten Dollars ($10.00) and other good and
valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Seller
does hereby grant, bargain, sell, convey, transfer and deliver unto ASI WINGS, LLC
("Purchaser"), all of Seller's right, title and interest in and to the Aircraft.
Seller hereby warrants to Purchaser, its successors and assigns, that Seller is the
lawful owner of the Aircraft and that there is hereby conveyed to Purchaser good and marketable
title to the Aircraft, free and clear of any and all liens, claims and encumbrances whatsoever, and
Seller will warrant and defend such title forever, at the sole expense of Seller, against all claims
and demands whatsoever. EXCEPT FOR THE WARRANTIES OF SELLER SET FORTH IN
THE PRECEDING SENTENCE, THE AIRCRAFT IS HEREBY SOLD TO PURCHASER IN
ITS "AS IS, WHERE IS" CONDITION AND "WITH ALL FAULTS."
IN WITNESS WHEREOF, Seller has caused this Warranty Bill of Sale to be
executed by its duly authorized officer, as of this )(,. day of July, 2011.
FREEDOM AIR INTERNATIONAL, INC.
By: flAJC.0- .
.A.V,,
Name: O. O...t
Title: te
Vi . ci
112071217388
$5.00 07/26/2011
EFTA00150993
EFTA00150994
FILED WITH FA A
AIRCRAFT RLc STR ATION
BR
2011 JUL 26 RIl 11 58
OXLAHOOA CITY
OKLAHOMA
FORM APPROVED
OMB No. 2120-0042
UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION 6
FEDERAL. AVIATION ADMINISTRATION-MIKE MONRONEY AERONAUTICAL CENTER ft)
-0
AIRCRAFT REGISTRATION APPLICATION CERT: ISSUE DATE Er
UNITED STATES
Al •
REGISTRATION NUMBER N —7
5cRAFT MANUFACTUR 8 MODEL
a e--+ode lie/ copkr a.
a
(S i Vows Vti -7 Cam- >
AIRCRAFT SERI No. co
c
-7 6 C -7 FOR FAA USE ONLY N
SO cn
TYPE OF REGISTRA heck One box) i1.)
O1. Individual O 2. Partnership . Corporation 04. Co-Owner ' 0 5. Government O
-.
0 8. Non-Citizen Corporation NM 9. Non-Citizen Corporation Co-Owner O
NAME OR APPLICANT (Person(s) shown on evidence of ownership. If individual, give last name. first name, and middle initial.)
Fer ec a o,,,,_ Ai r mar,+--tv-vtecf-iobtct.( .....k ran c •
TELEPHONE NUMBER: ( )
ADDRESS (Permanent mailing address for first applicant on list) (If P.O. Box is used, physical address must also be shown.)
Number and street:
Rural Route: P.O. Box:
CITY STATE ZIP • •
O CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS
ATTENTION! Read the following statement before signing this application.
This portion MUST be completed. -
A Nese or dishonest answer to any question In this application may be grounds for punishment by fine and/or imprisonment
(U.S. Code, Title 18. Sec. 1001).
CERTIFICATION
I/WE CERTIFY:
(1) That the above aircraft is owned by the undersigned applicant, who is a citizen (including corporations)
of the United States.
(For voting trust, give name of trustee: 1. Or:
" CHECK ONE AS APPROPRIATF•
a. A resident alien, with alien registration (Form 1-151 or Form 1-551) No.
A non-citizen corporation organized and doing business under the laws of (state)
b.
and said aircraft is based and primarily used in the United States. Records or flight hours are available for
inspection at
(2) That the aircraft is not registered under the laws of any foreign country; and
(3) That legal evidence of ownership Is attached or has been filed with the Federal Aviation Administration.
NOTE: If executed for co -ownership all applicants must sign. Use reverse side if necessary.
TYPE OR PRINT NAME BELOW SIGNATURE
SIGNATURE TITLE DATE
EACH PART OF THIS \
\A re SPvac,i cke 4 - a io
.c_
APPLICATION MUST
SIGNATURE TITLE DATE
102280834295
BE SIGNED IN INK.
SIGNATURE TITLES& DO 0-8/1 6/2010 DATE
NOTE Pending receipt of the Certificate of Aircraft Regis ration, the aircraft may be operated for a period not in excess of 90
days. during which time the PINK copy of this application must be carried in the aircraft. .
AC Form 8050-1 (1/09) (NSN 0052.00.628-9007) Supersedes Previous Edition
EFTA00150995
.
•
.
EFTA00150996
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE001916668
name change
rev/doi 022709
EFTA00150997
EFTA00150998
RECORDED CONVEYANCE FILED IN:
U.S. DEPARTMENT OF TRANSPORTATION NNUM:
FEDERAL AVIATION ADMINISTRATION SERIAL NUM:
MFR:
CROSS-REFERENCE—RECORDATION MODEL:
MR CARRIER:
This form is to be used in cases where a conveyance covers several aircraft and engines. propellers, or locations. File original of this form
with the recorded conveyance and a copy in each aircraft folder involved.
TYPE OF CONVEYANCE DATE EXECUTED
NAME CHANGE FEBRUARY 11, 2010
FROM DOCUMENT NO.
AIR OHISLAINE INC
TO OR ASSIGNED TO DATE RECORDED
SHMITKA AIR INC
MARCH 17. 2010
THE FOLLOWING COLLATERAL IS COVERED BY THE CONVEYANCE:
Total Aircraft: Total Engines: Total Props: Total Spare Pans:
tES-750-23R (ODOR)
EFTA00150999
EFTA00151000
80
Special Registration Number
0 ASSIGNMENT OF SPECIAL N7221E 0a
REGISTRATION NUMBERS
Present Registration Number
Aircraft Make and Model
u.s. OfeatenWat
KEYSTONE HELICOPTER S-76C
N750A 0
a vasosoortioon
Issue Date:
Federal Aviation Serial Number Mar 10, 2010
Administration 760750 N
This is your authoriy to change
FOR N722JE - 52325707
ICAO AIRCRAFT ADDRESS CODE the United States miss:scion
number on the above described
admit to the special
AIR GHISLAINE INC registratioo number shown.
C
arly duplicate or bit ram in the
i.,. ID il i toe i it' I 8' to s I to ilitelsIll aircraft together wi-h the
old registration certificate as
interim authority tooperate the
aircraft pending receipt of revised
certificate of regishatica
Obtain a revised ectificate of
airworthiners from your nue-
est Flight Standard :District
Office.
The latest FAA Form 81304,
Application For Airworthiness
on file is dated:
Jan 14, 2010
The airworthiness classification
sad category:
FJCPERIMENU
INSTRUCTIONS:
special
the Civil Aviation Registry, AFS-750, van= 5 days atter lute
SIGN AND RETURN THE ORIGINAL of this form to
registration number is placed on the aircraft. A revised certificate will then issued.
be
The authority to use the special number expires: Mar 10, 2011
rehisiwii00 minter was Plated RETURN FORM TO:
CERTIFICATION: I certify that
on the groan desaibed abo , AFS-750
ivil Aviation Re i
for Shmitka Air,
Signature of 1 ,..T Jac-
D reel r of Operations of
TidedOmml
Shmitka Air, Inc. f/k/a - '
—Ktr—shisIaineffnc.
Date Placed on Aircraft: 2A . I 5, 20/0
AC FORM ileSci-64 (5/2005) Stspenede Previous FAIden
EFTA00151001
EFTA00151002
FILED WITH FAA
ICq CR
AIRCRAFT RECISTRAT
2010 f9118 16 Pfl 1 15
OKLAHOMA CITY
OKLAHOMA
AMCRAFTnme SEARCHES Aero Records & Title Co.
RECORDING SERVICES O
AIRMEN RECORD INFORMADON a
February 11, 2010 3
Hand Delivered
To: FAA ?,
Oklahoma City. Oklahoma 7:4
FORM 8050-64 URGENTLY
NEEDED! PLEASE ISSUE AS O
Attention:
QUICKLY AS POSSIBLE. THANK YOU!!!
Gentlemen:
On behalf of our client:
AIR GHISLAINE INC.
Please initiate the following action:
Please ASSIGN special registration number N7223E, which is
reserved for our client, to the following described aircraft which
is registered in their name:
KEYSTONE HELICOPTER 8-76C
SERIAL NUMBER 760750
CURRENTLY N750A
PLEASE HAND THE ORIGINAL FORM 8050-64 TO ARTC - P.D. ROOM.
Thank you.
100431322316
$10.00 02/1212010
o PLEASE HAND CONFIRMATION OF RESERVATION LETTER TO ARTC - PUBLIC DOCUMENTSROOM.
PLEASE HAND ORIGINAL FORM 6060-64 TO ARTC - PUBLIC DOCUMENTS ROOM.
\li
llhankyOU.
AERO RECORDS &TITLECC
ek. L--Sij
leka
By: LISA THOMAS GASKIN/Senior Administrator, Special Services
/1g
Fee Attached' $10.00
CC: Christopher Shurkus
Sikorsky Aircraft
EFTA00151003
EFTA00151004
FILED.WITWIFAA
AIRCRAFT REGISTRATION aR
2010 FEB 12 P19 1 20
OKLAHOMA CITY
OKLAHOMA
FORM APPROVED
OMB No 2120-0042
UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION 0
FEDERAL AVIATION AtialeleSTRATION-ISKE IIIONNOINEV JuDIONAUNICAL CENTER 0
tD
AIRCRAFT REGISTRATION APPLICATION CERT. ISSUE DATE -cs
UNITED STATES CD
SI
REGISTRATION NUMBER 750A
AIRCRAFT MANUFACTURER & MODEL Key 54 o n e 14 e /.<0 p -pie (-
--5 - 444e -r-s -k-1, — A -4- rertrFt S-76C-2
AIRCRAFT SERIAL No. CD
IS
760750 FOR FAA USE ONLY
TYPE OF REGISTRATION (Check one box)
1%..)
0 1. Individual O 2. Partnership 19 3. Corporation O 4. Co-owner O 5. Gov't. O 8." °^Calizert 0
Corperallon 0
NAME OF APPLICANT (Person(s) shown on evidence of ownership. If individueJ, give last name, first name, end middle Initial.)
Air Ghislaine, Inc.
TELEPHONE NUMBER:
ADDRESS (Permanent missing address lot first applicant Meted.) (If P.O. BOX is used, physical address must also be shown.)
Number and street:
Rural Route: P,O. Box
CITY STATE ZIP CODE
O CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS
ATTENTION! Read the following statement before signing this application.
This portion MUST be completed.
A false or dishonest answer to any question in th-s application may be grounds for punistamont by fine and i or I mpensonment
(U.S. Code, The 18, Sec 1001).
CERTIFICATION
ID
SANE CERTIFY:
(1) That the above Wendt is owned by the undersigned applicant, who is a citizen (including corporations)
of the United States.
(For voting trust, give name of trustee: ) or
CHECK ONE AS APPROPRIATE:
a. O A resident alien, with ration registration (Form 1-151 or Form 1.551) No.
b. 0 A non-citizen corporation organized end doing business under the laws ol (state)
and Saki aircraft is based and primarily used In the United States Records or 'tight hours ate available for
inspection at
(2) That the aircraft Is not registered under the laws of any foreign country: and
(3) That legal evidence of ownership is attached or has been filed with the Federal Aviation Administration.
NOTE: II executed for co-ownership all applicants must sign. Use reverse side if necessary.
TYPE OR PRINT NAME E SI NATURE
SeGNATURE ca r TITLE GATE i
EACH PART CF THIS J5051(
11 . IteCAA- 7bi 4491 160 10242451 0 8 .
SIGNATURE TITLE DATE
APPLICATION MUST
L.P44 1-9 vt5OSN 4A.
BE SIGNED IN INK
SIGNATURE TITLE Ciatialfr43 ia 131 an
$5.00 02/17/2009
NOTE Pending receipt of the Cereffable of Aircraft Registration, Me aircraft may be operated for a period not in excess of 90
days, during which lime the PINK copy of this application must be carried in the aircraft.
AC Form 80661 (5/03) (0052-00-828-9007)
EFTA00151005
•••
'711, C• • "In
!vimo
•
130. "?: Wd Ll-'933 8002
31)%"...; 1.O1,220UIV
\WA ad
EFTA00151006
0
O
a
FORM APPROVED N
UNITED STATES OF AMERICA OMB NO 2120-0042
0
U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION 08/31/2008
7
AIRCRAFT BILL OF SALE
7
n
FOR AND IN CONSIDERATION OF $ THE
UNDERSIGNED OWNER(S) OF THE FULL LEGAL AND
BENEFICIAL TITLE OF THE AIRCRAFT DESCRIBED AS 8
FOLLOWS:
a
UNITED STATES
REGISTRATION NUMBER N 750A L.
co
0
AIRCRAFT MANUFACTURER 8 MODEL
Sikorsky Aircraft S-76C-2
AIRCRAFT SERIAL No. 8
760750
DOES THIS 304.4-
DAY OF December 2008 A
HEREBY SELL. GRANT. TRANSFER AND
DELIVER ALL RIGHTS, TITLE, AND INTERESTS
Do Not Write In This Block
IN AND TO SUCH AIRCRAFT UNTO: FOR FM USE ONLY
NAME AND ADDRESS
(IF INDIVIDUAL(S). GIVE LAST NAME. FIRST NAME. AND MIDDLE INITIAL.)
PURCHASER
Air Ghislaine. Inc.
083651547221
$5.00 12/30/2008
DEALER CERTIFICATE NUMBER
AND TO its successors gnetaltibesIeS. AND ASSIGNS TO HAVE ANO TO HOLD
SINGULARLY THE SAID AIRCRAFT FOREVER AND WARRANTS THE TITLE THEREOF:
IN TESTIMONY WHEREOF r HAVE SET MY HAND AND SEAL THIS DAY OF December. 2008
NAME(S) OF SELLER SIGNATURE(S) TITLE
(TYPED OR PRINTED) (IN INK) (IF EXECUTED FOR (TYPED OR PRINTED)
CCI-OWNERSHIP, MUST SIGN )
Sikorsky Aircraft Corporation S-76 Program Manager
LU
-1 Chns Shurkus
-1
U)
ACKNOwLEDGPAENT (NOT REQUIRED FOR PURPOSES OF FM 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
EFTA00151007
EFTA00151008
FILED WITH FAA
AIRCRAFT REGISTRATION BR
2008 DEC 30 HI 3 40
OKLAHOMA CITY
OKLAHOMA
Ir n
1s ocissa
too'. Neo S.
\co ovofre"0\
u, .430
01:0 1)° ;1.‘de3
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE000740071
ORIG DOC ID #0070 FFR 12-30-08 RET TO C&D
EFTA00151009
EFTA00151010
'0
O
O
UI
FORM APPROVED
UNITED STATES OF AMERICA OMB NO. 2120-0042
0
U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION 08/31/2008
AIRCRAFT BILL OF SALE CD
FOR AND IN CONSIDERATION OF $1fiatre THE
UNDERSIGNED OWNERS) OF THE FULL LEGAL AND
BENEFICIAL TITLE OF THE AIRCRAFT DESCRIBED AS 0
FOLLOWS: a
UNITED STATES
REGISTRATION NUMBER N 750A L
AIRCRAFT MANUFACTURER & MODEL
Keystone Helicopter Corporation S-76C
AIRCRAFT SERIAL No.
760750
DOES THIS J u DAY OF (• .
HEREBY SELL, GRANT, TRANSFER AND
DELIVER ALL RIGHTS, TITLE, AND INTERESTS
Do Not Write In This Block
IN AND TO SUCH AIRCRAFT UNTO: FOR FM USE ONLY
NAME AND ADDRESS
(IF INDWIDUAL(S), GIVE LAST NAME. FIRST NAME. AND MIDDLE INITIAL.)
PURCHASER
Sikorsky Aircraft Corporation
DEALER CERTIFICATE NUMBER
AND TO StateSSOLS LUCA/TOWS monnorMtmleR6. AND ASSIGNS TO HAVE AND TO HOLD
SINGULARLY THE SAID AIRCRAFT FOREVER AND WARRANTS THE TITLE THEREOF:
IN TESTIMONY WHEREOF HAVE SET my HAND ANO SEAL THIS O DAY OF L.CC. B-
211U
NAME(S) OF SELLER SIGNATURE(S) TITLE
(TYPED OR PRINTED) (IN INK) (IF EXECUTED FOR (TYPED OR PRINTED)
CO-OWNERSHIP. ALL MUST SIGN )
Keystone Helicopter Corporation President
LU
fraC7.74
David A Ford
-1
LLI
C/)
ACKNOWLEDGMENT (NOT REQUIRED FOR PURPOSES OF FM RECORDING HOWEVER. MAY RE REQUIRED BY LOCAL LAW FOR
VALIDITY OF THE INSTRUMENT.)
ORIGINAL' TO FM:
AC Form 8050-2 (9(92) (NSN 0052-00-829-0003) Supersedes Previous &MICR
EFTA00151011
EFTA00151012
FILED WITH FAA
AIRCRAFT REGISTRATION BR
2008 DEC 30 HI 3 40
OKLAHOMA CITY
OKLAHOMA
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE000740069
ORIG DOC ID #0068 FFR 12-30-08 RET TO C&D
EFTA00151013
EFTA00151014
Dec 22 2008 3:24PM HP LASERJET FAX P• 2
Keystone Helicopter
A Sikorsky Canpany
December 22, 2008
fel re blif
Flight Standards Service FIMA
Aircraft Re 'suasion Branch, AFS-I SO
incorrectly
Keystone Helicopter Corporation is requesting the correction of aircraft that what
been registered from our facility where registered as MODEL: S-76C-2,
registered. Some of the aircraft that have
been registered as S-
this is not in accordance with our type certificate data sheet (HINE); the aircraft should have
for any
76C. As the Aircraft manufacturer we are requesting that these please be corrected. We apologize
The following A/C Serial Numbers with the correspond ing N Number are affected
inconvenience this may cause.
by this error, they include:
Aircraft Serial Number Aircraft N Number
u2760686 718P
C011,760690 759P
g2760704 23W
g/760704...a> 4151'
e 60711 7571'
760714 714F
60717 767.1
(,760720 720G
cq,I60723 723Y
Q11760726 753P
G760729 799V
W/760731 781X
,760741 741A
60743 743N
60745 7456
60746 746K
1'760747 747Y
60748 748A
(6760750 750A
7W,60751 75 E
Ce,760753 753V
Regards,
Shaun M. Gebhard
S76 Quality Assurance Production Supervisor
EFTA00151015
EFTA00151016
EON DEC 22 IT( 3 00-
OKLAHOMA CITY • •
OKLAHOMA
MEMORANDUM TO THE FILE
JINNY ROSALES 09/9/2008
ID DATE
A Prior Record search was performed for KEYSTONE HELICOPTER CORP S-76C-2, 760750 on 9/9/2008. Search
results:
No Prior Record
Assigned N25DA
EFTA00151017
EFTA00151018
V S Department Flight Standards Service
of Transportation Aircraft Registration Branch. AFS-750
Federal Aviation
Administration WEB Address: httpfiregistry.faa.gov
September 9, 2008
Il Iu uullunlliuli 11tH iilrri
Dear Sirs:
United States identification mark N750A has been assigned to KEYSTONE HELICOPTER
CORP S-76C-2, serial number 760750, Mode S Transponder Code 52415011 as requested by
you. This manufacturer's assignment of special registration number cannot be used as an
authorization for a number change.
If w m ffrthr i n l ntact the Aircraft Registration Branch at
Sincerely,
Legal Instruments Examiner
Aircraft Registration Branch
AFS-750-SUPPORT-5 (9/04)
EFTA00151019
EFTA00151020
9/4/08
Federal Aviation Administration
Civil Aviation Registry
Aircraft Registration Branch
Attention: Central Records
Reference: Request for Manufacturer's
Registration Number Assignments
Gentlemen/Ladies:
This is written to request reservation &
assignment of the following special registration
numbers to the aircraft described below which are
presently under manufacture:
ALL ARE KEYSTONE HELICOPTER CORP.,
MODEL S-76C-2
REGISTRATION NO. SERIAL NO.
N741A 760741
N743N 760743
N745G 760745
N746K 760746
N747Y 760747
N748A 760748 /
N750A 760750j
N751E 760751
N753V 760753
Thank you.
Sincerely,
KEYSTONE HELICOPTER CORPORATION
By:
S76 Program Manager
CP3;\
COPY
EFTA00151021
VIVOL:V13/0
ADO yr
1V1)10
TS IT Wb
S d3S SOO?
as NOI.MIC
•.;
1.1VUOUIV
EFTA00151022
AIRCRAFT TITLE SEARCHES
RECORDING SERVICES
AIRMEN RECORD INFORMATION ro
L
September 5, 2008 A
Hand Delivered y
To: FAA
Oklahoma City, Oklahoma 0
Attention: Central Records §
4:a 1 7,4,.. IfiC.e7 •
4l.fr
Gentlemen: taivairxtir- -7 le-
On behalf of our client:
KEYSTONE HEL CTION
Please initiate the following action:
Please RESERVE and assign the following NINE (9) special
registration numbers to the aircraft listed below which are
presently under manufacture:
ALL ARE KEYSTONE HELICOPTER CORP.,
MODEL S-76C-2
REGISTRATION NO. SERIAL NO.
I N741A 760741
A N743N 760743
1 N745G 760745
4 N746K 760746
N747Y 760747
N748A 760748
N750A 760750
N751E 760751
q N753V 760753
PLFACE ISSUE FORM AFS-750-SUPPORT-5 TO THE MANUFACTURER, KEYSTONE
HELICOPTER CORP., AT THE ADDRESS SHOWN ABOVE. PLEASE HAND COPIES
OF THE MANUFACTURER ASSIGMENT LETTERS TO ARTC - P.D. ROOM.
Note: Enclosed is a "fax" letter by the manufacturer,
confirming their need for these assignments.
Thank you.
0824g1212072
590.00 CO/05120W
XI PLEASE HAND CONFIRMATION OF RESERVATION LETTER TO ARTC - PUBLIC DOCUMENTS ROOM.
CC`r:72 - co- — tctett-- 9(--0 -
\X5 PLEASE HAND OR401 -050-e4 TO ARTC - PUBLIC DOCUMENTS ROOM.
Thank you.
AERO RECO
By: LI THOMAS GASKIN/Senior Administrator, Special Services
/19 •
FeeAUSOMW:$94),‘";)
CC: Carl Kress
Keystone Helicopter Corp.
EFTA00151023
EFTA00151024
FILE!: .8 11.1 FAA
AIRCRAFT E .: V.;TRATICM RR
2008 SEP 5 API 11 51
OKLAH . ..IA CITY
OKLAFIUMA