337 Major Repair and Alteration

US Department MAJOR REPAIR AND ALTERATION of Transportation (Airframe, Powerplant, Propeller, or Appliance) Federal Aviation Administration

OMB No. 2120-0020 Exp: 1/31/2023

Electronic Tracking Number

For FAA Use Only

INSTRUCTIONS: Print or type all entries. See Title 14 CFR §43.9, Part 43 Appendix B, and AC 43.9-1 (or subsequent revision thereof) for instructions and disposition of this form. This report is required by law (49 U.S.C. §44701). Failure to report can result in a civil penalty for each such violation. (49 U.S.C. §46301(a))

1. Aircraft

Nationality and Registration Mark

Serial No.

Make

Model

Series

2. Owner

Name (As shown on registration certificate)

Address (As shown on registration certificate) Address City State Zip Country

3. For FAA Use Only

4. Type

5. Unit Identification

Repair

Alteration

Unit

Make

Model

Serial No.

AIRFRAME

(As described in Item 1 above)

POWERPLANT

PROPELLER

APPLIANCE

Type

Manufacturer

6. Conformity Statement

A. Agency's Name and Address

B. Kind of Agency

Name Address City State Zip Country

U. S. Certificated Mechanic

Manufacturer

Foreign Certificated Mechanic

C. Certificate No.

Certificated Repair Station

Certificated Maintenance Organization

D. I certify that the repair and/or alteration made to the unit(s) identified in item 5 above and described on the reverse or attachments hereto have been made in accordance with the requirements of Part 43 of the U.S. Federal Aviation Regulations and that the information furnished herein is true and correct to the best of my knowledge.

Extended range fuel per 14 CFR Part 43 App. B

Signature/Date of Authorized Individual

7. Approval for Return to Service

Pursuant to the authority given persons specified below, the unit identified in item 5 was inspected in the manner prescribed by the Administrator of the Federal Aviation Administration and is Approved Rejected

BY

FAA Flt. Standards Inspector

Manufacturer

Maintenance Organization

Persons Approved by Canadian Department of Transport

FAA Designee

Repair Station

Inspection Authorization

Other (Specify)

Certificate or Designation No.

Signature/Date of Authorized Individual

NOTICE

Weight and balance or operating limitation changes shall be entered in the appropriate aircraft record. An alteration must be compatible with all previous alterations to assure continued conformity with the applicable airworthiness requirements.

8. Description of Work Accomplished

(If more space is required, attach additional sheets. Identify with aircraft nationality and registration mark and date work completed.)

Nationality and Registration Mark Date

Additional Sheets Are Attached