U.S. DEPARTMENT OF TRANSPORTATION

FEDERAL AVIATION ADMINISTRATION

THIS FORM SERVES TWO PURPOSES

PART I acknowledges the recording of a security conveyance covering the collateral shown.

PART II is a suggested form of release which may be used to release the collateral from

the terms of the conveyance.
PART I CONVEYANCE RECORDATION NOTICE

NAME (last name first) OF DEBTOR

NAME and ADDRESS OF

NAME OF SECURED PARTY’S ASSIGNOR (if assigned)

Do Not Write In This Block

FOR FAA USE ONLY
FAA REGISTRATION NUMBER

AIRCRAFT SERIAL NUMBER

AIRCRAFT MFR. (BUILDER) and MODEL

ENGINE MFR. and MODEL

ENGINE SERIAL NUMBER(S)

PROPELLER MFR. and MODEL

PROPELLER SERIAL NUMBER(S)

THE DATED

COVERING THE ABOVE COLLATERAL WAS

THE CIVIL AVIATION REGISTRY ON

AS CONVEYANCE NUMBER

Gloria J. Watson
LEGAL INSTRUMENTS EXAMINER

PART II - RELEASE - (This suggested release form may be executed by the secured party and returned to the Civil Aviation Registry when terms of the conveyance have been satisfied. See below for additional information.)

THE UNDERSIGNED HEREBY CERTIFIES AND ACKNOWLEDGES THAT THEY ARE THE TRUE AND LAWFUL HOLDER OF THE NOTE OR OTHER EVIDENCE OF INDEBTEDNESS SECURED BY THE CONVEYANCE REFERRED TO HEREIN ON THE ABOVE DESCRIBED COLLATERAL AND THAT THE SAME COLLATERAL IS HEREBY RELEASED FROM THE TERMS OF THE CONVEYANCE. ANY TITLE RETAINED IN THE COLLATERAL BY THE CONVEYANCE IS HEREBY SOLD, GRANTED TRANSFERRED, AND ASSIGNED TO THE PARTY WHO EXECUTED THE CONVEYANCE, OR TO THE ASSIGNEE OF SAID PARTY IF THE CONVEYANCE SHALL HAVE BEEN ASSIGNED: PROVIDED, THAT NO EXPRESS WARRANTY IS GIVEN NOR IMPLIED BY REASON OF EXECUTION OR DELIVERY OF THE RELEASE.

This form is only intended to be a suggested form of release, which meets the recording requirements of the Federal Aviation Act of 1958, and the

DATE OF RELEASE

regulations issued thereunder. In addition to these requirements, the form used by the security holder should be drafted in accordance with the

pertinent provisions of local statutes and other applicable federal statutes.
(Name of security holder)
This form may be reproduced. There is no fee for recording a release.

Send to Aircraft Registration Branch, P.O. Box 25504, Oklahoma City,

SIGNATURE (In Ink)
OK 73125.

TITLE

Paperwork Reduction Act Statement: The information collected on this form is necessary to obtain authorization to transmit information to the International Registry. The information is a condition for the issuance of a unique authorization code. We estimate that it will take approximately 1 hour to complete the form. Please note that any 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. OMB 2120-0043 Expires 06/09

“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, ABA-20”
(A person signing for a corporation must be a corporate officer or hold a managerial position and must show his title. A person signing for another should see parts 47 and 49 of the Federal Aviation Regulations (14 CFR))

ACKNOWLEDGMENT (If Required By Applicable Local Law):
AC Form 8050-41 (5/06)

DEPARTMENT OF TRANSPORTATION FORM APPROVED

Barbara Lee

2006-05-18

Gloria J. Watson

FAA