Text extracted via OCR from the original document. May contain errors from the scanning process.
PPM! AVIATION ADMINISTRATOR - MIKE MONRONEY AERONAUTICAL CENTER
1
UNITED STAS
REGISTRATIO
TEN N 722JE
HUMBER
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TYRE OF
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NRCRAFT
Sikorsky S-76C
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ASKRAFT
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NUMBER
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CERTIFICATION
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mod page and add pagers) it necessary.
Cr I up. us rt.:icos or
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NOTE 11 <aoudad
.. regershan
sign. Use
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,
SIGNATURE:
DATE:
(.0_. 1/.1
Ei
TYPED/PRINTED
*WE:
Lawrence P. Visoski, R.
TIRE. µ any
2
SIGNATURE:
DATE
TYPED/PRWTED
HARE
TITLE-
1107£ Except when the most recent nredstrabon el the sae abode is expired of amcensd, 14 CFR 47 31(c) rides for an airworthy U.S.
arra to to operated for up to 93 drys within the WWII States when a copy of the %grad application for Its mistrytkei mated in the draelt
rs eyeing Issuance and receipt at the row registrstion cortalta.
0
0
o)
AC Form ao50.1 (101 9)
EFTA00075689
FILED-WITH FAA
AIRCRAFT
REGISTRATION BR
1014 JUN I 3 AN
12
OKLAHOMA CITY
, OKLAHOMA
EFTA00075690
OocuSign Envelope ID: 7C21388F-7DCCA,O6B-9CC1-7C830CC9F594
FORM APPROVED
OMB NO. 2120-0042
Do Not Witte In This Block
FOR
UNDERSIGNED
AND
CRIBED
AND IN CONSIDERATION OF $
THE
AS FOLLOWS:
UNITED STATES
N722JE
Keystone (Sikorsky) model S-76C
AIRCRAFT SERIAL NO. 760750
DOES THIS
l3
DAY OF June, 2019,
AND
INTERESTS
IN AND TO SUCH AIRCRAFT • UNTO:
PURCHASER
(IF INDIVIDUAL (S). GIVE LAST NAME. FIRST NAME. AND MIDDLE INITIAL )
Milli
m.
IN TESTIMONY WHEREOF, THE UNDERSIGNED HAS SET ITS HAND THIS t3
DAY OF "SLASA-
2019.
SELLER
(TYPED OR PRINTED)
SIGNATURE(S)
(IN BLUE INK) (IF EXECUTED
SIGN)
TITLE
(TYPED OR PRINTED)
ASI WINGS LLC
By: Aetna Inc., its Managing
Member
DocuSigned by:
Ejo.skt-S a,,t
?IC 7.OO072EMSI
Senior Vice President,
controller & Chief
Accounting Officer
James D. Clark
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.
ADMIN 35381002v1
191641014476
55.00 06/13/2019
O
O
0
0
0
0 a
0
O
O
CO
0
(.4
EFTA00075691
FILED WITH FAA
AIRCRAFT
REGISTRATION BR
1019 JUN 13 AU 10: 12
OKLAHOMA CITY
OKLAHOMA
EFTA00075692
OMB Control Number 21204729
apices 0480/1 7
Paperwork Reduction Act Statement: The information collected on this form is necessary to maintain aircraft registration. We estimate that it 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 collection 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
FtESULT W CANCELLA DON OF REGISTRATION
(See Id C.F.R. §§ 47.15(0, 47.40 and 47.49
N 722JE
SERIAL NUMBER
760750
MANUFACTURER
MODEL
S.76C
08/16/2011
08/31/2020
CORPORATION
(Owner 1)
ASI WINGS LLC
Review Aircraft Registration File Information for this aircraft
at: http://reeistry.faa.ciovfaircrattinquirv.
(Owner 2)
Assistance may be obtained
at our web page: http:/freclistry.faa.qOWrenewreqiStratiOn
Hai Enter any additional owner names on page two.
(Address)
bye-mad at:
by telephone at::
When mailing fees, please use a check or money order made
payable to the Federal Aviation Administration.
Signature and Title Requirements for Common Registration Types:
- Individual
owner must sign, title would be 'owner'.
- Pannership
general partner signs showing -general partner' as
title.
- Corporation
corporate officer or manager signs, showing lull title.
- Limited Liability Co authorized member, manager, or officer identified in
the LLC organization document signs. showing full title.
-
Co-ownernment
authorized person must sign and show their full title.
each co-owner must sign: showing 'co-owner-as title.
.
ve
Note: All signatures must be In ink, or other permanent media.
To correct entries: Draw a single line through error. Make correct entry in
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.
(Address)
City
State a
Zip
Country
UtorEo STATES
Physical Address: Required *nen mailing address is a P.O. Box or mai drop.
(Address)
(Address)
City
State
Zip
Country
TO RENEW REGISTRATION: REVIEW aircraft registration information.
SELECT the appropriate statement, fiNTER any change in address in the
spaces below aritl, pia. a SEND form with the $5 renewal fee to the:
FAA
by courier
i
O
NEW
Aircraft Registry, PO Box 25504. Oklahoma City OK 73125-0504. or
to: 6425 S Denning Rm 118, Oklahoma City OK 73169-6937
MEETS CITIZENSHIP REQUIREMENTS OF 14 CFR §47.3, AIRCRAFT IS
REQUIREMENTS OF 14 CFR §47.3. AIRCRAFT IS NOT REGISTERED
MAILING ADDRESS
CHECK All pplicable block(s) below r.OMPiFTF alath DATE & M611.
.8
tli
(Shaw purchaser's name and address.)
NEW PHYSICAL ADDRESS: complete if physical address has changed, or
the new mailing address is a PO Box or Mail 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)
Electroncally Certified by Registered Owners
(required field)
TITLE-
111.t., id field)
DATE
3/28/2017
SIGNATURE OF OWNER 2
TITLE
DATE
Use page 2 for additional signatures.
Fix paid: $5 (201703281I52554432NB)
..1( • Form 5051 - I B (04:12)
EFTA00075693
EFTA00075694
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
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
NAME OF OWNER
DATE
SIGNATURE
TITLE
AC Form 8050-113 (04/12)
REF N-NUM: 122.IE
EFTA00075695
EFTA00075696
>
E
6
g
12
AI I ORNEYS
Ed COUNSELORS
lb a
co
August 4, 2014
c
9.
O
V2
Jana L. Hammer, 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 Ms. Hammer:
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
142161527019
$2.00 08/04/2014
• Oklahoma City, OK
•
• Fax:
www.debeegilchrist.com
EFTA00075697
FILED WITH FAA
4IRM%Fr ;.ECISTRATION BR
2014 RUG 4 PITI 3 26
OKLAHOMA CITY
OKLAHOMA
EFTA00075698
S Deparf•
of Tta-spooation
Federal Aviation
Administration
Date of Issue: August 4, 2014
ASI WINGS LLC
Flight Standards Service
Aircraft Registration Branch,
AFS-750
HAND DELIVERED TO 'GIL IN THE PD ROOM
ress: httpwreglstry.taa.gov
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)
EFTA00075699
EFTA00075700
PRINT PAGE 1
r
PRIVACY ACT STATEMENT]
OMB Control Noway 2120.0129
Empires 05.51/2014
Paperwork Reduction Act Statement: The inl0miali0N COSeCted on the form is necessary to maintain aircraft registration. Wo estimate that it wW lake approximately 30 minutes
to complete the form. Please note that an agency may not conduct or sponsor. and a person is not require() to respond lo. a collection of information unless II displays a wthd
OMB oentroi number. Form Approved. OMB No. 2120-0729 'Comments concerning the accuracy of this burden and suggestions for reducing the burden srbauld be directed to
the FAA M: BOO Independence Avenue SW. Washington. DC 20591. AlTN: Inform:ion Collection Clearance Ottrcer.AES-200.'
DEPARTMENT OF TRANSPORTATION • FEDERAL AVIATION ADMINISTRATION
(See 14 C.F.R. §§ 47.15(9, 47.40 end 47.41)
N 722JE
MANUFACTURER
Keystone Helicopter
August 16.2011
SERIAL NUMBER
760750
MODEL
S-76C
August 31, 2014
(Owner 1)
ASI Wings LLC
(Owner 2)
Was Enter any additions owner names on page two.
(Address)
(Address
City
State ■
Zip
Country
Physical Address: Required when mating address is a P.O. Box or mail drop.
(Address)
(Address)
City
State
Zip
Country
TO RENEW REGISTRATION: REVIEW aircraft registration information.
SELECT the appropriate statement, FNTER any change in address in the
spaces below. M.
DATE & SENO form with the $5 renewal fee to the:
FAA Aircraft Registry, PO Box 25504, Oklahoma City OK 73125-0504, or
by courier to: 6425 S Denning Room 118, Oklahoma City OK 73169.6937
a
MEETS CITIZENSHIP REQUIREMENTS OF 14 CFR S47.3. AIRCRAFT IS
El
REQUIREMENTS OF 14 CFR S47.3. AIRCRAFT IS NOT REGISTERED
NEW PHYSICAL ADDRESS: complete if physical address has changed, or
the new mailing address is a PO Box or Mail Drop.
Corporation
Review Aircraft Registration Fite Information for this aircraft
at: httolireoistry.faa.cov/aircraftinouirV.
Assistance may be obtained
at our web page:
It 1/re ist
yfr never
I it ti n
by e-mail at:
by telephone al:
When mailing fees, please use a check or money order made
payable to the Federal Aviation Administration.
Signature and Title Requirements for Common Registration Types:
• Individual
owner must sign, title would be -owner.
Partnership
general panne( signs showing 'general partner as Ctle.
Corporation
corporate officer or manager signs, showing fun title.
- Limited Liability Co authorized member, manager, or officer identified In the
LLC organization document signs. showing full title.
• Co-owner
each co-owner must sign; showing 'co-owner es title.
• Government
authorized person must sign and show their rue title.
Note: All signatures must be in Ink, or other permanent media.
To correct entries: Draw a single line through error. Make correct entry in
remain'Ag space, or complete the form on-iine. An application form will be
rejected If any entry is covered by correction tape or similarly obscured.
gifEcK 011 applicable Necks below, COMPLETE, $1o. DATE a tag. this
loan with any fees to the: FAA Aircraft Registry.
PO Box 25504, Oklahoma City, OK, 73125-0504, or by courier to:
6425 S Denning Rm. 118, Oklahoma City OK 73169-6937
a
▪
(Show purchaser's name and address.)
K
K
OTHER, Specify
PLEASE RESERVE N-NUMBER IN THE OWNER'S NAME
AND ADDRESS. The $10 reservation tee is enclosed.
SIGNATURE OF OWt
1
puked field)
linda Westbrook
(required field)
TITLE
(required geld)
Ass Mani Capon/Is Sean, 01 Aetna Inc,
Minn.( of AS! WINGS. tic
DATE
SIGNATURE OF OWNER 2
TITLE
DATE
Use page 2 for additional signatures.
8
V
a a
mm
L
C
R.1
O
AC Form 8050-I B (04/12)
EFTA00075701
FILED WITH FAA
IIRCF!ar PEGISTRATION 6R
NH JUL 14 FYI 11 16 I
OKLAHOMA CITY
OKLAHOMA
EFTA00075702
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE006014974
FFR -1B DOC ID 8018 5/1/14
141211307096 $5 5/1/14
EFTA00075703
EFTA00075704
V S Department
of Transportation
Federal Aviation
Administration
December 11, 2012
111
Dear Sirs:
Flight Standards Service
Aircraft Registration Branch. AFS-750
WEB Address: httpfiregistry.faa.gov
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 i
Manager, Aircraft Registration Branch, AFS-750
AFS-750-RE1tEG-14 (09/10)
EFTA00075705
EFTA00075706
V S Department
of Transportation
Federal Aviation
Administration
October 12, 2012
Dear Sirs:
Flight Standards Service
Aircraft Registration Branch. AFS-750
..m...„,nimmilmim
WEB Address: ettp:firegistry.faa.gov
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
Manager, Aircraft Registration Branch, AFS-750
AFS-750-REREG-13 (03/11)
EFTA00075707
EFTA00075708
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
FAA Aircraft Registration Branch
P.O. Box 25504
Oklahoma City. OK 73125-0504
Commercial Delivery Scn•icc@:
FAA Aircraft Registration Branch
Registry Building. Rim 118
6425 South Denning
Oklahoma City, OK 73169-6937
Make fee payment by check or money order payable to the Federal Aviation Administration.
For additional information call toll free 1-866-762-9434. or visit hurrfiregistrv.faa.gov
FAX No: (405) 954-3548
Dear Aircraft Registry:
K Special registration number N162AE. was not painted on KEYSTONE HELICOPTER S-76C serial
number 760750.
K I/We do not wish to reserve this number at this time.
K Please reserve this N162AE in our name. The $10.00 special N-number reservation fee is
enclosed.
K Please assign N162AE to
KEYSTONE
S-76C
760750
HELICOPTER
On
(Mate)
Maki
I Saul Number)
for an N-number change. $20.00 is enclosed to cover both the special number request and
assignment fees.
K Special registration number N162AE, was placed on KEYSTONE HELICOPTER S-76C serial number
760750 on
Luc,. Please issue a revised registration certificate.
K The completed and signed Assignment of Special Registration Numbers. AC Fonn 8050-64. is
enclosed.
K 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)
EFTA00075709
EFTA00075710
0
U.S. Department
of Transporlation
Federal Aviation
Administration
Special Registration Number
N162AE
Aircraft Make and Model
KEYSTONE HELICOPTER S-76C
Present Registration Number
N722JE
Serial Number
760750
Issue Date:
Sep 16, 2011
ICAO AIRCRAFT ADDRESS CODE FOR N162AE - 50174441
nu
I I II II w
m
This is your authority to change
the United States registration
number on the above described
aircraft to the special
registration number shown.
Carry duplicate of this fonn in the
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
on the aircraft described above.
Signature of Owner:
RETURN FORM TO:
Civil Aviation Re 'sin, AFS-750
Title of Owner:
Date Placed on Aircraft:
AC FORIN 8050-64
(5/2005) Supersedes Pen ion, Edition
EFTA00075711
EFTA00075712
LI
Insured Aircraft Title Service, Inc.
Oklahoma City, Ok
Oklahoma City, Ok
e-mail address:
web site: www.insure airs .com
Date:
August 26, 2011
Dear Sir/Madam:
Please Reserve N
in NAME ONLY for:
FAX
Please Reserve N 162AE•
N# Change Request
and assign for the following aircraft:
N 722JE
Make
Keystone Helicopter Model
S-76C
Serial #
760750
Which is (1) being purchased by
ASI Wings LLC
(2) registered to
XX
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
EFTA00075713
FILED WITH FAA
AIRCRAFT RECISTRATI011 DR
2011 AUG 26 NI 1 56
OKLAHOMA CITY
OKLAHOMA
EFTA00075714
FORM APPROVED
OMB No. 2120-0042
I
I1
i
I
I
'
UNITED STATES
722JE
Keystone
(Sikorsky)
S-76C
AIRCRAFT SERIAL No.
760750
TYPE OF REGISTRATION (Chock One box)
I i
O1. Individual
O 2. Partnership
IZSI 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
ADDRESS
Number
Rural Route:
(Permanent mailing address for first applicant on list) (If P.O. Box is used, physical address must also be shown.)
and street:
P.O. Box:
CITY
O
A false
11
1
I/WE CERTIFY:
(1) That
of the
(For
CHECK
STATE
ATTENTION! Read the following statement before signing
This portion MUST be completed.
or dishonest answer to any question In this application may be grounds for punishment
(U.S. Code. Title 18. Soc. 1001).
CERTIFICATION
ZIP CODE
OF ADDRESS
this application.
by fine and/or imprisonment
corporations)
) or:
the above aircraft is owned by the undersigned applicant, who Is a citizen (Including
United States.
voting trust, give name of trustee:
or Fonn 1-551) No.
a.
b.
(2) That
(3) That
TYPE
A resident alien, with alien registration (Form 1-151
A non-citizen corporation organized and doing
and said aircraft is based and primarily used in
inspection at
business under the laws of (state)
the United States. Records or Eight hours are available for
the aircraft is not registered under the laws of any foreign country: and
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.
BE SIGNED IN I
.
SI NATURE.
Allstant
Corporate
ecretary
of Aetna
Inc.
DATE
,7;210
- 0
SIGNA
Melinda
Westbrook
MaAaging Member of
ASI Wings, LLC
DATE
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
EFTA00075715
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
EFTA00075716
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
U.S. Registration No. N722JE, with two (2) Turbomcca Arriel 2S2 engines bearing
Manufacturer's Serial Nos. 42285 and 42286, together with all avionics, equipment (including
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
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.
By:
flAJC.0-.A.V
. ,,
Name:
O.
O...t
Title:
Vi .te
ci
112071217388
$5.00 07/26/2011
0
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CO
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0
3
3
0
ro a
EFTA00075717
FILED WITH FAA
AIRCRAFT RLc STR ATION BR
2011 JUL 26 RIl 11 58
OXLAHOOA CITY
OKLAHOMA
EFTA00075718
FORM APPROVED
OMB No. 2120-0042
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UNITED STATES
—7 a e--
Al • RAFT MANUFACTUR
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Vti
8 MODEL
+ode lie/ copkr
Cam-
-7
AIRCRAFT SERI
No.
-7
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C
-7
SO
O1. Individual
O 2. Partnership
0 8. Non-Citizen Corporation
heck One box)
. Corporation
04. Co-Owner '
0 5. Government
Co-Owner
NM 9. Non-Citizen Corporation
NAME OR APPLICANT (Person(s) shown on evidence of
Ferec a o,,,,_ Ai r
)
ownership. If individual, give last
+--tv-vtecf-iobtct.(
name. first name, and middle initial.)
.....
k ran
c •
mar,
ADDRESS (Permanent mailing address for first applicant on list) (If P.O. Box is used, physical address must
Number and street:
Rural Route:
P.O. Box:
also be shown.)
CITY
O
CHECK HERE
ATTENTION! Read
A Nese or dishonest answer to
I/WE CERTIFY:
(1) That the above aircraft is owned
of the United States.
(For voting trust, give name
"
CHECK ONE AS APPROPRIATF•
IF YOU ARE ONLY
the following
This portion
any question In this application
(U.S. Code,
CERTIFICATION
STATE
ZIP
• •
ADDRESS
-
imprisonment
1. Or:
statement before signing
MUST be completed.
may be grounds for punishment
Title 18. Sec. 1001).
OF
this application.
by fine and/or
corporations)
by the undersigned applicant, who is a citizen (including
of trustee:
or Form 1-551) No.
a.
b.
(2) That
(3) That
TYPE
A resident alien, with alien registration (Form 1-151
A non-citizen corporation organized and doing
and said aircraft is based and primarily used in
inspection at
business under the laws of (state)
the United States. Records or flight hours are available for
the aircraft Is not registered under the laws of any foreign country; and
legal evidence of ownership Is attached or has been tiled with the Federal Aviation Administration.
NOTE: If executed for co-ownership all applicants must sign. Use reverse side if necessary.
SIGNATURE
\
TITLE
\A re SPv ac,i cke 4 -
DATE
a io
SIGNATURE
.c_
TITLE
102280834295
DATE
SIGNATURE
TITLES& DO 0-8/16/2010
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
EFTA00075719
.
.
•
EFTA00075720
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE001916668
name change
rev/doi 022709
EFTA00075721
EFTA00075722
CROSS-REFERENCE—RECORDATION
NNUM:
SERIAL NUM:
MFR:
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.
NAME CHANGE
DATE EXECUTED
FEBRUARY 11, 2010
FROM
DOCUMENT NO.
SHMITKA AIR INC
DATE RECORDED
MARCH 17. 2010
Total Aircraft:
Total Engines:
Total Props:
Total Spare Pans:
tES-750-23R (ODOR)
EFTA00075723
EFTA00075724
0
u.s. OfeatenWat
a row spoloon
Federal Aviation
Adrninistratioo
Special Registration Number
N7221E
Aircraft Make and Model
KEYSTONE HELICOPTER S-76C
Present Registration Number
N750A
Serial Number
760750
Issue Date:
Mar 10, 2010
ICAO AIRCRAFT ADDRESS CODE FOR N722JE - 52325707
AIR GH1SLAINE INC
Inellli sr ii I
HI i Ise I 8' to s I teltio
This is your authoity to change
the United States on/oration
number on the above described
anaaft to the special
the
C
reentrance number shoves.
(OM in
arly duplicate orbit
llsIll
aircraft together wit the
old registration certificate as
interim authority cooperate the
aistraft pending reaipt of revised
certificate of regisontice.
Obtain a revised outificate of
airworthiness from your nod-
est Flight Standard :Disoiu
Office.
The latest FAA Form 81304,
Application For Airworthiness
on file Is dated:
Jan 14, :010
The airworthiness classification
sad category:
FJCPERIMENU
INSTRUCTIONS:
SIGN AND RETURN THE ORIGINAL of this form to the Civil Aviation Registry, AFS-750, van= 3 clays alter the spxial
registration number is placed on the aircraft. A revised certificate will then be issued.
The authority to use the special number expires: Mar 10, 2011
CERTIFICATION: I certify
on the aircraft denibed abo
Signature of
that
registration number "3 placed
for Shrnitka Air,
1
Jai_
RETURN FORM TO:
Civil Aviation Re '
, AFS-750
D reel
TittedOwner 0hmitka
-Ktr—snisIaineffric.
r of Operations of
Air, Inc. f/k/a - '
Date Placed on Aircraft:
2k
/ 5, 20/0
AC FORM •050-64 (5/2005) Saptnedes Previous &Man
8 0
0 a
0tr
N
EFTA00075725
FILED WITH FAA
AIRCRAFT RECISTRATICq CR
2010 f9118 16 Pfl 1 15
OKLAHOMA CITY
OKLAHOMA
EFTA00075726
OP.
Amcruwrnme SEARCHES
MECORDINGSEMMUM
February 11, 2010
Hand Delivered
To:
FAA
Oklahoma City. Oklahoma
Attention:
Gentlemen:
On behalf of our client:
INS
Please initiate the following action:
FORM 8050-64 URGENTLY
NEEDED! PLEASE ISSUE AS
QUICKLY AS POSSIBLE. THANK YOU!!!
tie Co.
Please
ASSIGN
special
registration
number
N722.71C,
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.
1004313223/8
$10.00 02/1212010
\it'
PLEASE HAND ORIGINAL FORM 8050-64 TO ARTC - PUBLIC DOCUMENTIIIROOM.
ankyou.
eit L--S ij leka
By: LISA THOMAS GASKIN/Senior Administrator, Special Services
/1g
Fee Attached' $10.00
Sikorsky Aircraft
O
a
3
7:4
O
EFTA00075727
FILED.WITWIFAA
AIRCRAFT REGISTRATION aR
2010 FEB 12 P19 1 20
OKLAHOMA CITY
OKLAHOMA
EFTA00075728
FORM APPROVED
OMB No. 2t20-0042
FEDERAL AVLEIVON aDawasTRATION-SE aliCeladinee ruarteatainiCAL Castrate
UNITED STATES
SI
750A
Key 54 o n e
f-iff
/0 CO p -pie (-
--5 -444e -r-s -k-1, -
A -4- rertrFt
S -76C -2
AIRCRAFT SERIAL No.
760750
TYPE OF REGISTRATION (Check one box)
0
1. Individual
O
2. Partnership
19 3. Corporation
O
4. Co-owner
O
5. Gov't.
O
8. Pe°^Calizerl
Corpwallon
NAME OF APPLICANT (Person(s) shown on evidence of ownership. ft individueJ, give last name, first name, and middle Initial.)
Air Ghislaine, Inc.
ADDRESS
Number
Rural
(Permanent mailing address for first applicant listed.) (If P.O. BOX is used, physical address must also be shown.)
and street
Route
PO. Box
CTTY
O
A false
(U.S.
ID
VWE
(1) That
of
(For
CHECK
STATE
ATTENTION! Read the following statement before signing
This portion MUST be completed.
or dishonest answer to any question in th-s application may be grounds for punishment
Code, lltht 18. Sec 1001).
CERTIFICATION
this application.
by fine
corporations)
ZIP CODE
OF ADDRESS
and / or imposonment
) or:
CERTIFY:
the above Wendt is owned by the undersigned applicant, who is a citizen (including
the United States.
voting trust, give name of trustee:
1-151 or Form 1.551) No.
a.
b.
(2) That
(3) That
TYPE
O
A resideM alien, with allen registration (Form
O
A non-citizen commotion organized and doing
and said aircraft is based and prfmadly used in
inspection at
business under the laws of (state)
the United States Records or flight hours are available for
Administration.
side if necessary.
the aircraft is not registered under the laws of any foreign country: and
legal evidence of ownership is attached or has been filed with the Federal Aviation
NOTE: If executed for co-ownership all applicants must sign. Use reverse
OR PRINT NAME :E a:LISIGNATURE
SIGNATUR a
ITLE
T
1
P;i
fete
jA
AL
teA)
DAT E
/
i
432429 dog
7 6
-
SIGNA
a
TITLE
DATE
SIGNATURE
TITLE
OO541Fir-39131
$5.OO
02/17/2009
GTE
NOTE
Pending receipt of the Certificate 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 8050.1 (5/03) (0052-00-628-9007)
EFTA00075729
•••
'711, C• • "In
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!vimo
130. "?: Wd Ll-'933 8002
31)%"...;
1.O1,220UIV
\WA
ad
EFTA00075730
FOR AND IN CONSIDERATION OF $
THE
FOLLOWS:
UNITED STATES
N 750A
AIRCRAFT MANUFACTURER 8 MODEL
Sikorsky Aircraft S-76C-2
AIRCRAFT SERIAL No.
760750
DOES THIS
304.4-
DAY OF
December
2008
FORM APPROVED
OMB NO 2120-0042
08/31/2008
Do Not Write In This Block
FOR FM USE ONLY
PURCHASER
Air Ghislaine, Inc.,
083651547221
$5.00 12/30/2008
AND TO its successors
gnetaltibesreS.
HAVE SET
MY
DAY OF December. 2008
LU
-1
-1
U)
(TYPED OR PRINTED)
SIGNATURE(S)
(IN INK) (IF EXECUTED FOR
CCILOWNERSHIP,
MUST SIGN
Sikorsky Aircraft Corporation
TITLE
(TYPED OR PRINTED)
S-76 Program Manager
Chns Shurkus
ACKNOwLEDGPAENT (NOT REQUIRED FOR PURPOSES OF FM RECORDING: HOWEVER. MAY BE REQUIRED BY LOCAL LAW FOR
ORIGINAL TO FAA
AC Form 8050-2 (9/92) (NSN 0052-00.629.0003) Supersedes Previous Edition
'0
0
0
N
01
0
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0
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8
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8
A
Lit
EFTA00075731
FILED WITH FAA
2008 DEC 30 HI 3 40
OKLAHOMA CITY
OKLAHOMA
ocis Ir n
1s
S.
sa
too'. "0\ Neo
\co ovofreu,
.430
01:0
1)° ;1.‘de3
EFTA00075732
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE000740071
ORIG DOC ID #0070 FFR 12-30-08 RET TO C&D
EFTA00075733
EFTA00075734
FOR AND IN CONSIDERATION OF $1fiatre THE
FOLLOWS:
UNITED STATES
N 750A
Keystone Helicopter Corporation S-76C
AIRCRAFT SERIAL No.
760750
DOES THIS
J u
DAY OF
( •
.
FORM APPROVED
OMB NO. 2120-0042
08/31/2008
Do Not Write In This Block
FOR FM USE ONLY
PURCHASER
(IF INDWIDUAL(S), GIVE LAST NAME. FIRST NAME. AND MIDDLE INITIAL.)
Sikorsky Aircraft Corporation
AND TO
StateSSOLS
farsGAZORS. monnorMtmleR6. AND ASSIGNS TO HAVE AND TO HOLD
HAVE SET my
O
DAY OF
L.CC. 211U
LU
-1
LLI
(/)
(TYPED OR PRINTED)
SIGNATURE(S)
(IN INK) (IF EXECUTED FOR
TITLE
(TYPED OR PRINTED)
Keystone Helicopter Corporation
fraC7.74
President
David A Ford
ORIGINAL' TO FM:
AC Form 8050-2 (9(92) (NSN 0052-00-829-0003) Supersedes Previous &MICR
B-
'0
O
O
UI
0
0
a
CD
L
EFTA00075735
FILED WITH FAA
2008 DEC 30 HI 3 40
OKLAHOMA CITY
OKLAHOMA
EFTA00075736
DOCUMENT LEVEL ANNOTATIONS FOR DOCUMENT ARE000740069
ORIG DOC ID #0068 FFR 12-30-08 RET TO C&D
EFTA00075737
EFTA00075738
Dec 22 2008 3:24PM
HP LASERJET FAX
P • 2
Keystone Helicopter
A Sikorsky Canpany
December 22, 2008
Flight Standards Service
Aircraft Re 'suasion Branch, AFS-I50
Keystone Helicopter Corporation is requesting the correction of aircraft that what incorrectly
registered. Some of the aircraft that have been registered from our facility where registered as MODEL: S-76C-2,
this is not in accordance with our type certificate data sheet (HINE); the aircraft should have been registered as S-
76C. As the Aircraft manufacturer we are requesting that these please be corrected. We apologize for any
inconvenience this may cause. The following A/C Serial Numbers with the corresponding N Number are affected
by this error, they include:
Aircraft Serial Number
Aircraft N Number
u2760686
718P
C31,760690
759P
(j2760704
23W
4151'
7571'
714F
767.1
(,760720
720G
723Y
753P
799V
781X
741A
743N
7456
746K
747Y
748A
750A
75 E
753V
Regards,
Shaun M. Gebhard
S76 Quality Assurance Production Supervisor
no Helicopter Corporation
g'760704...,s>
e 60711
760714
60717
y1,160723
Q.6760726
G760729
W/760731
,760741
60743
60745
60746
1'760747
60748
(6760750
7W
E,0751
Ce,760753
00 EtSV
Mobile:
Desk:
Fax
fel re blif
FIMA
EFTA00075739
EON DEC 22 IT( 3 00-
OKLAHOMA CITY
•
•
OKLAHOMA
EFTA00075740
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
EFTA00075741
EFTA00075742
V S Department
of Transportation
Federal Aviation
Administration
September 9, 2008
COATEN'. ii l I' PA
Dear Sirs:
Flight Standards Service
Aircraft Registration Branch. AFS-750
WEB Address: httpfiregistry.faa.gov
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 we may
f further assistance. please contact the Aircraft Registration Branch at
Sincerely,
Legal Instruments Examiner
Aircraft Registration Branch
AFS-750-SUPPORT-5 (9/04)
EFTA00075743
EFTA00075744
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:
MODEL S-76C-2
SERIAL NO.
N741A
760741
N743N
760743
N745G
760745
N746K
760746
N747Y
760747
N748A
760748 /
N750A
760750j
N751E
760751
N753V
760753
Thank you.
Sincerely,
By:
S76 Program Manager
CAFI-\
COPY;
EFTA00075745
VIVOL:V13/0
ADO yr 1V1)10
TS IT Wb S d3S SOO?
as NOI.MIC
•.; 1.1VUOUIV
EFTA00075746
September 5, 2008
Hand Delivered
To:
FAA
Oklahoma City, Oklahoma
Attention:
Gentlemen:
On behalf of our client:
Central Records
4:.‘- '7,44.-Ifr:"?:" •
4l.fr
t eak.c.,,--3,r- -7 le-
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:
MODEL S -76C-2
I N741A
A N743N
N745G
4 N746K
N747Y
N748A
N750A
N751E
q
N753V
SERIAL NO.
760741
760743
760745
760746
760747
760748
760750
760751
760753
PLFACE ISSUE FORM AFS-750-SUPPORT-5
KEYSTONE
Note: Enclosed is a "fax" letter by the manufacturer,
confirming their need for these assignments.
Thank you.
0824g1212072
590.00 09/0512008
CC-7:12.
—
tctett--
9r--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),‘";)
Keystone Helicopter Corp.
ro
L
A
y
0
§
EFTA00075747
FILE!: .8 11.1 FAA
AIRCRAFT E .:
V.;TRATICM RR
2008 SEP 5
API 11 51
OKLAFIUMA
EFTA00075748