Form 8130-3 Authorized Release Certificate

1. Approving National Aviation
Authority/Country:

OMB Control No. 2120-0018
09/30/2007
3. Form Tracking Number:

2.

AUTHORIZED RELEASE CERTIFICATE
FAA Form 8130–3, AIRWORTHINESS APPROVAL TAG

4. Organization Name and Address:

6. Item:

7.

Description:

5. Work Order/Contract/Invoice
Number:
8.

Part Number:

9.

Eligibility: *

10.

Quantity:

11.

Serial/Batch Number:

12.

Status/Work:

13. Remarks:

14. Certifies the items identified above were manufactured in conformity to:

19.

14 CFR 43.9 Return to Service

Other regulation specified in Block 13

Certifies that unless otherwise specified in Block 13, the work identified in Block 12
and described in Block 13 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.

Approved design data and are in a condition for safe operation.
Non-approved design data specified in Block 13.

15. Authorized Signature:

16. Approval/Authorization No.:

20. Authorized Signature:

21. Approval/Certificate No.:

17. Name (Typed or Printed):

18. Date (m/d/y):

22. Name (Typed or Printed):

23. Date (m/d/y):

User/Installer Responsibilities
It is important to understand that the existence of this document alone does not automatically constitute authority to install the part/component/assembly.
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 parts/components/assemblies from the airworthiness authority of the country specified in
Block 1.
Statements in Blocks 14 and 19 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 (6–01)

*Installer must cross-check eligibility with applicable technical data.

NSN: 0052-00-012-9005

Paperwork Reduction Act Statement:
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number associated
with this collection of information is 2120-0018. Comments concnerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at:
800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance OFficer, ABA-20.