FAA-8130-6 Application for US Airworthiness Certificate

INFORMATION FOR APPLICANT

U.S. Department
of Transportation

Federal Aviation
Administration

APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE
Privacy Act Statement
Information on FAA F orm 8130-6, Application for U. S. Airworthiness Certificate is solicited
under the authority of 49 U.S.C. 44103 as implemented by 14 CFR Part 21. The purpose
of this inf ormation is to evaluate an applic ant’s application for a U.S. Airworthin ess
Certificate. Submission of this data is mandatory and will bec ome part of the Privacy Act
system of records DOT/FAA 801, Aircraft Regi stration System. Incomplete submission
may result in delay or denial of your reques t. Information maint ained in the Privacy Act
system of records is routinely us ed to (1) provide aircraft owners and operators informa tion
about potential mechanical defects or unsafe conditions of thei r aircraft i n the form of
airworthiness directives, (2) locate spec ific individuals or aircraft for a ccident investigation,
violation, or safety related requir ements, (3) prepare an Aircraft Registry in magnetic t ape
and microfiche form as required by ICAO
agreement, containing in formation on airc raft
owners by name, address, United States Registration Num ber, and type of aircraft, and (4)
DOT Prefatory Statement of General Routine Uses.

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not
required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of
information subject to the requirements of the Paperwork Reduction Act unless that collection of information
displays a currently valid OMB Control Number. The OMB Control Number for this information collection is
2120-0018. Public reporting for this collection of information is estimated to be approximately 42 minutes per
response, including the time for reviewing instructions,searching existing data sources, gathering and
maintaining the data needed, completing and reviewing the collection of information. All responses to this
collection of information are required to obtain or retain benefits per 14 CFR Part 21. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information
Collection Clearance Officer, ASP-110.

TEAR OFF THIS COVER SHEET BEFORE SUBMITTING THIS FORM

FAA Form 8130-6 (4/11) All Previous Editions Superseded

FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE

Form Approved O.M.B. No. 2120-0018
Expiration Date 04/30/2015

I. AIRCRAFT
DESCRIPTION

U.S. Department
of Transportation
Federal Aviation
Administration
1. REGISTRATION MARK

APPLICATION FOR
U.S. AIRWORTHINESS
CERTIFICATE

INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA
use only. Submit original only to an authorized FAA Representative. If additional
space is required, use attachment. For special flight permits complete Sections
II, VI, and VII as applicable.

2. AIRCRAFT BUILDER’S NAME (Make)

3. AIRCRAFT MODEL DESIGNATION

4. YR. MFR.

5. AIRCRAFT SERIAL NO.

6. ENGINE BUILDER’S NAME (Make)

7. ENGINE MODEL DESIGNATION

8. NUMBER OF ENGINES

9. PROPELLER BUILDER’S NAME (Make)

10. PROPELLER MODEL DESIGNATION

FAA CODING

11. AIRCRAFT IS (Check if applicable)
IMPORT

APPLICATION IS HEREBY MADE FOR: (Check applicable items)
STANDARD AIRWORTHINESS CERTIFICATE (Indicate category)

B

SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items)

II. CERTIFICATION REQUESTED

A 1
7

PRIMARY

9

LIGHT-SPORT (Indicate Class)

2

LIMITED

5

PROVISIONAL (Indicate class)

to be conducted)

to be conducted)

8

6

UTILITY

III. OWNER’S CERTIFICATION

COMMUTER

Weight-Shift-Control

Glider

BALLOON

OTHER

Lighter than Air

CLASS I

2

CLASS II

1

AGRICULTURE AND PEST CONTROL

2

AERIAL SURVEY

3

AERIAL ADVERTISING

4

FOREST (Wildlife conservation)

5

PATROLLING

6

WEATHER CONTROL

0

OTHER (Specify)

1

RESEARCH AND DEVELOPMENT

2

AMATEUR BUILT

3

EXHIBITION

4

AIR RACING

5

CREW TRAINING

6

MARKET SURVEY

0

TO SHOW COMPLIANCE WITH THE CFR

7

OPERATING (Primary Category) KIT BUILT AIRCRAFT

8

OPERATING
LIGHT-SPORT

9

UNMANNED
AIRCRAFT

Existing aircraft without an airworthiness certificate & do not meet § 103.1

8B

Operating Light-Sport Kit-built

8C

Operating light-sport previously issued special light-sport category airworthiness
certificate under § 21.190

9A

RESEARCH AND DEVELOPMENT

9B

MARKET SURVEY

9C

CREW TRAINING

1

FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE

SPECIAL FLIGHT PERMIT (Indicate

2

EVACUATE FROM AREA OF IMPENDING DANGER

operation to be conducted, then complete
Section VI or VII as applicable on reverse side)

3

OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT

4

DELIVERING OR EXPORTING

6

CUSTOMER DEMONSTRATION FLIGHTS

5

PRODUCTION FLIGHT TESTING

MULTIPLE AIRWORTHINESS CERTIFICATE (Check ABOVE “Restricted Operation” and “Standard” or “Limited” as applicable)
IF DEALER, CHECK HERE

NAME

ADDRESS

B. AIRCRAFT CERTIFICATION BASIS (Check applicable blocks and complete items as indicated)
AIRCRAFT SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (Give No. and

AIRWORTHINESS DIRECTIVES (Check if all applicable ADs are complied with and give the number

Revision No.)

of the last AD SUPPLEMENT available in the biweekly series as of the date of application)

AIRCRAFT LISTING (Give page number(s))

SUPPLEMENTAL TYPE CERTIFICATE (List number of each STC incorporated)

C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH
14 CFR section 91.417

TOTAL AIRFRAME HOURS

3

EXPERIMENTAL ONLY (Enter hours flown since last certificate issued
or renewed)

D. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Aviation Administration in
accordance with Title 49 of the United States Code 44101 et seq. and applicable Federal Aviation Regulations, and that the aircraft has been inspected and is airworthy and eligible for the
airworthiness certificate requested.
DATE OF APPLICATION

IV. INSPECTION
AGENCY
VERIFICATION

TRANSPORT

1

A. REGISTERED OWNER (As shown on certificate of aircraft registration)

V. FAA REPRESENTATIVE
CERTIFICATION

ACROBATIC

Power-Parachute

8A

EXPERIMENTAL (Indicate operation(s)

4

C

Airplane

RESTRICTED (Indicate operation(s)

3

NORMAL

NAME AND TITLE (Print or type)

SIGNATURE

A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183(d) applies)
2
5

14 CFR part 121 CERTIFICATE HOLDER (Give
Certificate No.)

3

CERTIFICATED MECHANIC (Give Certificate No.)

CERTIFICATED REPAIR STATION (Give Certificate
No.)

AIRCRAFT MANUFACTURER (Give name or firm)

DATE

TITLE

SIGNATURE
THE CERTIFICATE REQUESTED

(Check ALL applicable block items A and B)

A. I find that the aircraft described in Section I or VII meets requirements for
B. Inspection for a special flight permit under Section VII
was conducted by:
DATE

6

MIDO/FSDO
OFFICE

4

AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE

FAA INSPECTOR

FAA DESIGNEE

CERTIFICATE HOLDER UNDER

14 CFR part 65

FAA INSPECTOR’S SIGNATURE or DESIGNEE’S
SIGNATURE AND NO.
4

FAA Form 8130-6 (4/11) All Previous Editions Superseded

14 CFR part 121 OR 135

14 CFR part 145

FAA INSPECTOR’S CERTIFICATION FILE REVIEW
SIGNATURE
1

Electronic Format –PDF

Page 1 of 2

A. MANUFACTURER

VI. PRODUCTION
FLIGHT TESTING

NAME

ADDRESS

B. PRODUCTION BASIS (Check applicable item)
PRODUCTION CERTIFICATE (Give production certificate number)
TYPE CERTIFICATE
OTHER:
C. GIVE QUANTITY OF CERTIFICATES REQUIRED FOR OPERATING NEEDS
NAME AND TITLE (Print or type)

DATE OF APPLICATION

SIGNATURE

VII. SPECIAL FLIGHT PERMIT PURPOSES OTHER THAN PRODUCTION FLIGHT TEST

A. DESCRIPTION OF AIRCRAFT
REGISTERED OWNER

ADDRESS

BUILDER (Make)

MODEL

SERIAL NUMBER

REGISTRATION MARK

B. DESCRIPTION OF FLIGHT
FROM

CUSTOMER DEMONSTRATION FLIGHTS
TO

VIA



(Check if applicable)

DEPARTURE DATE

DURATION

C. CREW REQUIRED TO OPERATE THE AIRCRAFT AND ITS EQUIPMENT
PILOT

CO-PILOT

FLIGHT ENGINEER

OTHER (Specify)

D. THE AIRCRAFT DOES NOT MEET THE APPLICABLE AIRWORTHINESS REQUIREMENTS AS FOLLOWS:

E. THE FOLLOWING RESTRICTIONS ARE CONSIDERED NECESSARY FOR SAFE OPERATION: (Use attachment if necessary)

F. CERTIFICATION - I hereby certify that I am the registered owner (or his agent) of the aircraft described above; that the aircraft is registered with the Federal Aviation
Administration in accordance with Title 49 of the United States Code 44101 et seq. and applicable Federal Aviation Regulations; and that the aircraft has been inspected and is
safe for the flight described.

VIII. AIRWORTHINESS
DOCUMENTATION (FAA/DESIGNEE
use only)

DATE

NAME AND TITLE (Print or type)

SIGNATURE

A. Operating Limitations and Markings in Compliance With 14 CFR Section 91.9,
As Applicable
B. Current Operating Limitations Attached

G. Statement of Conformity, FAA Form 8130-9 (Attach when required)
H. Foreign Airworthiness Certification for Import Aircraft
(Attach when required)
I. Previous Airworthiness Certificate Issued in Accordance With

C. Data, Drawings, Photographs, etc. (Attach when required)

14 CFR Section

CAR

(Original attached)

D. Current Weight and Balance Information Available in Aircraft
E. Major Repair and Alteration, FAA Form 337 (Attach when required)

14 CFR Section

(Copy attached)

K. Light-Sport Aircraft Statement of Compliance, FAA Form 8130-15 (Attach
when required)

F. This inspection Recorded in Aircraft Records

FAA Form 8130-6 (4/11) All Previous Editions Superseded

J. Current Airworthiness Certificate Issued in Accordance With

Electronic Format –PDF

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