Form 8710-3 Agricultural Aircraft Operator Certificate Application

AGRICULTURAL AIRCRAFT OPERATOR CERTIFICATE APPLICATION

US Department
of Transportation
Federal Aviation
Administration

Paperwork Reduction Act Statement: The information collected on this form is required. This form is submitted to
determine eligibility for the issuance of the Agriculture Aircraft Operator Certificate. Confidentially is neither requested nor
provided. We estimate that it will take 1 hour to complete the form. Please note that 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.
The OMB control number associated with this collection is 2120-0049. Comments concerning 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, ASP-110.

SUPPLEMENTAL
INFORMATION
Form 8710-3 (12/16)

Form Approved
OMB No. 2120-0049
08/31/2021

INSTRUCTIONS
Complete form in its entirety
Submit to the local Flight Standards
District Office

AGRICULTURAL AIRCRAFT OPERATOR
CERTIFICATE APPLICATION

US Department
of Transportation
Federal Aviation
Administration

TYPE

1. APPLICATION
FOR

ECONOMIC POISONS

AMENDMENT

COMMERCIAL

OTHER THAN ECONOMIC POISONS

REISSUANCE

2. NAME AND ADDRESS OF APPLICANT

3. PRINCIPAL OPERATIONS BASE (Airport, City, State)

TELEPHONE NUMBER

TELEPHONE NUMBER
INDIVIDUAL

4. OPERATING
AS

5. NAME OF CHIEF SUPERVISOR OF OPERATIONS (Commercial Operations Only)

OTHER (Specify)

CORPORATION
(First)

PARTNERSHIP

6. AIRMAN CERTIFICATE HELD

(Middle Initial)

GRADE

RATINGS
TYPE RATING(S) (Specify)

ASEL

AMES

COMMERCIAL

AMEL

HELICOPTER

AIRLINE TRANSPORT

ASES

GYROPLANE

NO
YES (Complete 7B)

DO YOU HOLD A CURRENTLY EFFECTIVE CERTIFICATE OF WAIVER FOR
CONDUCTING AGRICULTURAL AIRCRAFT OPERATIONS?

7B. WAIVER HELD

(Last)

CERTIFICATE NUMBER

PRIVATE

7A.

ORIGINAL

FOR DISPENSING (Check one)

PRIVATE

DATE ISSUED

EXPIRATION DATE

FAA DISTRICT OFFICE WHERE ISSUED

8. AGRICULTURAL AIRCRAFT TO BE OPERATED
MAKE

EQUIPPED FOR

MODEL

LIQUID

SOLID

TOTAL NUMBER EACH
AIRCRAFT OPERATED

REGISTRATION MARK
(List a minimum of one)

9. LIST THE NAME(S) AND AIRMAN CERTIFICATE NUMBER(S) OF AGRICULTURAL PILOT(S) WORKING FOR YOU AT THE PRESENT TIME
(Use separate sheet and attach if additional space is needed.)
NAME

CERT. NO.

NAME

CERT. NO.

10. REMARKS (if applicable)

11. CERTIFICATION: I CERTIFY THAT STATEMENTS MADE ON THIS FORM ARE TRUE AND CORRECT.
DATE

TITLE

FAA Form 8710-3 (12/16) SUPERSEDES PREVIOUS EDITION

SIGNATURE

Page 1

INSPECTION REPORT - For FAA Use Only
(To be completed by the General Aviation for Flight Standards District Office)
COMPLIANCE WITH APPLICABLE REGULATIONS
1. PILOTS

NOT REQUIRED

SATISFACTORY

UNSATISFACTORY

A. CERTIFICATES
B. RATING(S)
C. KNOWLEDGE TEST
D. SKILL TEST
2. AIRCRAFT
A. CERTIFICATED
B. AIRWORTHY
C. EQUIPPED FOR AGRICULTURAL OPERATIONS
10. REMARKS (Include an explanation of denial if application is disapproved).

4. DISTRICT OFFICE ACTION
CERTIFICATE ISSUED

INSPECTORS SIGNATURES

APPLICATION DISAPPROVED
DATE INSPECTION COMPLETED

FAA Form 8710-3 (12/16) SUPERSEDES PREVIOUS EDITION

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