Form 8710-3 Agricultural Aircraft Operator Certificate Application

AGRICULTURAL AIRCRAFT OPERATOR CERTIFICATE APPLICATION

US Department
of Transportation
Federal Aviation
Administration

Paperwork Reduction Act Statement: A federal agency may not conduct a 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 current valid OMB control number.
The OMB Control Number for this information collection is 2120-0049. Public reporting for this collection of information is
estimated to be approximately 30 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 voluntary. Send comments regarding this burden or estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

SUPPLEMENTAL
INFORMATION
Form 8710-3 (12/16)

Form Approved
OMB No. 2120-0049
05/31/2018

INSTRUCTIONS
Complete form in its entirety
Submit to the local Flight Standards
District Office

AGRICULTURAL AIRCRAFT OPERATOR
CERTIFICATE APPLICATION

US Department
of Transportation
Federal Aviation
Administration

TYPE

1. APPLICATION
FOR

ECONOMIC POISONS

AMENDMENT

COMMERCIAL

OTHER THAN ECONOMIC POISONS

REISSUANCE

2. NAME AND ADDRESS OF APPLICANT

3. PRINCIPAL OPERATIONS BASE (Airport, City, State)

TELEPHONE NUMBER

TELEPHONE NUMBER
INDIVIDUAL

4. OPERATING
AS

5. NAME OF CHIEF SUPERVISOR OF OPERATIONS (Commercial Operations Only)

OTHER (Specify)

CORPORATION
(First)

PARTNERSHIP

6. AIRMAN CERTIFICATE HELD

(Middle Initial)

GRADE

RATINGS
TYPE RATING(S) (Specify)

ASEL

AMES

COMMERCIAL

AMEL

HELICOPTER

AIRLINE TRANSPORT

ASES

GYROPLANE

NO
YES (Complete 7B)

DO YOU HOLD A CURRENTLY EFFECTIVE CERTIFICATE OF WAIVER FOR
CONDUCTING AGRICULTURAL AIRCRAFT OPERATIONS?

7B. WAIVER HELD

(Last)

CERTIFICATE NUMBER

PRIVATE

7A.

ORIGINAL

FOR DISPENSING (Check one)

PRIVATE

DATE ISSUED

EXPIRATION DATE

FAA DISTRICT OFFICE WHERE ISSUED

8. AGRICULTURAL AIRCRAFT TO BE OPERATED
MAKE

EQUIPPED FOR

MODEL

LIQUID

SOLID

TOTAL NUMBER EACH
AIRCRAFT OPERATED

REGISTRATION MARK
(List a minimum of one)

9. LIST THE NAME(S) AND AIRMAN CERTIFICATE NUMBER(S) OF AGRICULTURAL PILOT(S) WORKING FOR YOU AT THE PRESENT TIME
(Use separate sheet and attach if additional space is needed.)
NAME

CERT. NO.

NAME

CERT. NO.

10. REMARKS (if applicable)

11. CERTIFICATION: I CERTIFY THAT STATEMENTS MADE ON THIS FORM ARE TRUE AND CORRECT.
DATE

TITLE

FAA Form 8710-3 (12/16) SUPERSEDES PREVIOUS EDITION

SIGNATURE

Page 1

INSPECTION REPORT - For FAA Use Only
(To be completed by the General Aviation for Flight Standards District Office)
COMPLIANCE WITH APPLICABLE REGULATIONS
1. PILOTS

NOT REQUIRED

SATISFACTORY

UNSATISFACTORY

A. CERTIFICATES
B. RATING(S)
C. KNOWLEDGE TEST
D. SKILL TEST
2. AIRCRAFT
A. CERTIFICATED
B. AIRWORTHY
C. EQUIPPED FOR AGRICULTURAL OPERATIONS
10. REMARKS (Include an explanation of denial if application is disapproved).

4. DISTRICT OFFICE ACTION
CERTIFICATE ISSUED

INSPECTORS SIGNATURES

APPLICATION DISAPPROVED
DATE INSPECTION COMPLETED

FAA Form 8710-3 (12/16) SUPERSEDES PREVIOUS EDITION

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