DS9 Document EFTA00307677

.?t; 4 -II( • Zi • 41 • UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION FaMPALMnadloti AOMMIIMUMON-MIKE MCNINONM Nmostarcet. coma tatcrten REGISTRATION APPLICA11014 REGITatta TATE NuMBER S 722JE AlliCt4ANUFACkIRER 81400EL Keystone (Sikorsky) S-76C NRCPAFT SERIAL Na. 760750 TYPE OF FtEGISTRADON (Check Ono box) O 1. Individual 02. Partnership 't el 3. Corporation 04. Co- S. Co Cik crnt O 8. Non- en Corporal O 8. Non-Citizen -Ow er NAME OR APPUCANT Persen(s) shown on evidence of ownership. It IncsvkluSt Pm I Mme. tint flan". FORM APPROVED 0141 No. 2120-0042 ASI Wings, LLC TespiroNEpiumem, ( 860) 273-0386 k 0 1410QPCS (Permanent meaty address for fat &Wanton list) V P.O NW and 151 Farmington Ave W street- Rural Route: CITY Hartford Q CHECK HERE IF YOU ARE ATTENTION! Read the folio This A false or Odhoneet answer to any question in this cation S. IN?E CERTIFY'. (1) That the 'stove of t of?need Prelota4eliont'..giventovie OffeliONE !VS APpROPRIA a. A resident Oen, with „ . b. A nea.catzen and said that Inspection at (z) That the Masa is n (31 Tut MON t( 4°.1c 0 EP to US iratial.) tract also 00 shown) CODE 6156 j ell& *CRAN ADDRESS OrMsignmotnigappScanom mpteted. nits for punishment line and/or anon:torment upu. YY t. who Is a Citizen (including dons) or Form 1-551) No I Or. Ot"ness undo( the laws of (state) in MO Intel StatearRecords dr light hours are WOW. Ice' ,of any Ian caned': and hes ern tied with the redeem, Aviation AdmIntstAttion. ship akepplicantsniust sign. Use reverse side it necessary. GNATURE distant Corporate cretary of Aetna Inc gi Member of ASI Wings, LLC DATE *4 DAT: GATE NOTE Pending now the Cert;ficate of Aircraft Registration. thb aircraft may be operated tore period not in excess of 90 demm, during water tme the PINK copy of tens appfleation rntot be carded in the aircraft. AC Form 8050-1 (1/09( (NSN 00524:104128-9007)Supeisecke Previous Edition EFTA00307677 FORM APPROVED OMB No. 2120.0042 IMMO STATES OF AMERICA MOW. MARTON AodeonATION-DoitinoCosioNalf AIRCRAFT DEPARTMON OF TRANSPORTATION MONONalnicu, cENTII. TICKAPLICAT/ON s CERT: ATE AEGAWN t rAle talliER N AlliCRAFTSItUkaC7URER S. S .-ROC . TYPE OF ?Tr AARON (Choc* One boon' 01. Individual '. 2. Portant* On 3. Coiparatfon 0 4.4c b . 0 a0 Non.aaten Ccdponttion 0 9. NonCilizen NAME CFI APPLICANT (Pattc410,thOWIN on temente of Pomfret*. M IndlAdoef. 9101 . fret name. Imre) re-estdcA4,-, Air-tx4--c o f tnc. A. TEUFPNONETAIMEIER:. f } ' eQ .ACOREbS (Permanent walling lobos, kit And • amarcray on 'dr) (r P. neat So bet lelOVAL) Nurbor and Soar 103 Fad U2C.. IDA) Rural Roulec F. CITY VNI ; i O ft i tit. 7.91 COPE 113%03 0 CHECK HER Oti ARE EP A thipmer 60 ADORESS 4 ATTENTION! R the folio s to tore signing this applipation. . . . - ' This p to US • mpieted. ' A *nor dishonest annoy. to any Weeti011 in lids catwn nit lot pirtehmeof by Ins OMAN InICOSOMMet s. 0, 1i.. oc 100i). WIVE CERTIFY: CFMICtL1011 te That the abode Stith Is aimed underAm +ph Is a /Fero 0 999100 900 0,911a1 (For bating mot, live name of SATECESITigh.0 " or El or Fi;r4:1-5ily No. .":.,4,.... ..e1P,Id"1. , . . ,, lo, Anon-all:en trasineasundor the laws of (state) - and sakfaiferah Z,rhuny in the UMW States,' Rooarda or Ott Mum so arable for irtil:OCtiOn at fittnat maairorrA a of any IofeiPn and I. ter fidA . has been ANT Sada Avlation Adirenbbeillon. .. ..... • ' ,, NOT 91. i hip an applicants must sign. Us* reverse side if necessary, TYPE OR E 9 GNATURE A EACH PART OF tHIS PPLICATi ON MUST BE a MORE. , IT I .0.453treS ike 4 + £ KC t lets DATE NATURE TITLE GATE NOTE Pending receipt of IIACartebbabeof Nicraft RedinstralioA the aircraft maybe opiates for a period not in *roses of 90 Goya. Outing ANNA Wry. IN PINK owl of Ws application must be owned in the Monk AC Pam 9060-t (1/09) (NSN 0052.00-928-9C07) Superset/es Pte iota EditIon EFTA00307678