Form 8130-6 Application for U.S Airworthiness Certificate

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

Form Approved OMB No. 2120-0018
Expires: January 31, 2021

INFORMATION FOR APPLICANT

APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE
Privacy Act Statement
Privacy Act Statement (5 U.S.C. § 552a(e)(3))
Authority: The authority for collecting this information on FAA Form 8130-6, Application for U.S.
Airworthiness Certificate is contained in 49 U.S.C. § 44103 as implemented by 14 CFR Part 21.
Purpose: The purpose of this information is to evaluate an applicant’s eligibility for a U.S.
Airworthiness Certificate.
Routine Uses: In accordance with the Privacy Act System of Records Notice (SORN), DOT/FAA
801, Aircraft Registration System, will be routinely disclosed:
 To the public (including government entities, title companies, financial institutions,
international organizations, FAA designee airworthiness inspectors, and others) information,
including aircraft owner’s name, address, United States Registration Number, aircraft type,
legal documents related to title or financing of an aircraft, and ADS–B summary reports. Email
addresses, credit card information, and telephone numbers of small unmanned aircraft
system (sUAS) owners registered under 14 CFR part 48 will not be disclosed pursuant to this
Routine Use. The public may only retrieve the name and address of owners of sUAS
registered under 14 CFR part 48 by the unique identifier displayed on the aircraft.
 To law enforcement, when necessary and relevant to a FAA enforcement activity.
The Department has also published 15 additional routine uses applicable to all DOT Privacy Act
system of records. These routine uses are published in the Federal Register at 84 FR 55222 October 15, 2019 and 77 FR 42796 - July 20, 2012, and under ‘‘Prefatory Statement of General
Routine Uses’’ (available at https://www.transportation.gov/privacy/privacyactnotices).
Disclosure: Submission of this data is voluntary, however incomplete submission may result in
delay or denial of your request.
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: Information Collection
Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 761771524.

TEAR OFF THIS COVER SHEET BEFORE SUBMITTING THIS FORM

FAA Form 8130-6 (06/20) SUPERSEDES PREVIOUS EDITION

Form Approved OMB No. 2120-0018
Expires: January 31, 2021

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

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

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

APPLICATION IS HEREBY MADE FOR: (Check applicable items)
A
1
STANDARD AIRWORTHINESS CERTIFICATE (Indicate category)
B

NORMAL

UTILITY

FAA CODING

11. AIRCRAFT IS (Check if applicable)
IMPORT

TRANSPORT

COMMUTER

BALLOON

OTHER

SPECIAL AIRWORTHINESS CERTIFICATE (Check appropriate items)
7

PRIMARY

9

LIGHT-SPORT (Indicate Class)

2

LIMITED

5

PROVISIONAL (Indicate class)

II. CERTIFICATION REQUESTED

to be conducted)

Power-Parachute

Glider

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

SHOW COMPLIANCE WITH THE CFR

7

OPERATING (Primary Category) KIT BUILT AIRCRAFT

8

OPERATING
LIGHT-SPORT

to be conducted)

8

Weight-Shift-Control

1

EXPERIMENTAL (Indicate operation(s)

4

C

Airplane

RESTRICTED (Indicate operation(s)

3

8A

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

9D

EXHIBITION

9C

CREW TRAINING

9E

SHOW COMPLIANCE WITH THE CFR

9

UNMANNED
AIRCRAFT

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)

6

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

IF DEALER, CHECK HERE

NAME

III. OWNER’S CERTIFICATION

ACROBATIC

4. YR. MFR.

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

Revision No.)

number 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

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

3

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

NAME AND TITLE (Print or type)

SIGNATURE

IV. INSPECTION
AGENCY
VERIFICATION

A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN INSPECTED AND FOUND AIRWORTHY BY: (Complete the section only if 14 CFR part 21.183(d) applies)
14 CFR part 121 CERTIFICATE HOLDER

2

(Give Certificate No.)

CERTIFICATED MECHANIC (Give Certificate No.)

3

CERTIFICATED REPAIR STATION (Give Certificate No.)

AIRCRAFT MANUFACTURER (Give name or firm)

5
DATE

TITLE

SIGNATURE

(Check ALL applicable block items A and B)

V. FAA
REPRESENTATIVE
CERTIFICATION

6

THE CERTIFICATE REQUESTED

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

MIDO/FSDO
OFFICE

4

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.

FAA Form 8130-6 (06/20) SUPERSEDES PREVIOUS EDITION

14 CFR part 121 OR 135

14 CFR part 145

FAA INSPECTOR’S CERTIFICATION FILE REVIEW SIGNATURE
1

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Form Approved OMB No. 2120-0018
Expires: January 31, 2021

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

NAME AND TITLE (Print or type)

SIGNATURE

A. DESCRIPTION OF AIRCRAFT
REGISTERED OWNER

ADDRESS

BUILDER (Make)

MODEL

SERIAL NUMBER

REGISTRATION MARK

B. DESCRIPTION OF FLIGHT
FROM

CUSTOMER DEMONSTRATION FLIGHTS
TO

VII. SPECIAL FLIGHT PERMIT PURPOSES OTHER THAN PRODUCTION FLIGHT TEST

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)

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

SIGNATURE

G. Statement of Conformity, FAA Form 8130-9 (Attach when required)

B. Current Operating Limitations Attached

H. Foreign Airworthiness Certification for Import Aircraft
(Attach when required)

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

I. Previous Airworthiness Certificate Issued in Accordance With

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

14 CFR Section

FAA Form 8130-6 (06/20) SUPERSEDES PREVIOUS EDITION

(Original attached)

J. Current Airworthiness Certificate Issued in Accordance With
14 CFR Section

F. This inspection Recorded in Aircraft Records

CAR

(Copy attached)

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