Form 8710-15 LIGHT-SPORT AIRCRAFT STATEMENT OF COMPLIANCE

Form Approved
OMB No. 2120-0690
Exp.10/31/2018

Information for Applicant

LIGHT-SPORT AIRCRAFT
STATEMENT OF COMPLIANCE
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 2120-0690.
Public reporting for this collection of information is estimated to be approximately 20 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 a benefit by 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: Information Collection Clearance Officer,
Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

Privacy Act Statement
Information on FAA Form 8130-15, Light-Sport Aircraft Statement of Compliance is
solicited under the authority of 49 U.S.C. 44103 as implemented by 14 CFR Part
21. The purpose of this information is to evaluate an applicant’s statement of
compliance for light-sport aircraft. Submission of this data is mandatory and
will become part of the Privacy Act system of records DOT/FAA 801,
Aircraft Registration System. Incomplete submission may result in delay or denial
of your request. Information maintained in the Privacy Act system of records is
routinely used to (1) provide aircraft owners and operators information about
potential mechanical defects or unsafe conditions of their aircraft in the
form of airworthiness directives, (2) locate specific individuals or aircraft for
accident investigation, violation, or safety related requirements, (3) prepare
an Aircraft Registry in magnetic tape and microfiche form as required
by ICAO agreement, containing information on aircraft owners by name,
address, United States Registration Number, and type of aircraft, and (4)
DOT Prefatory Statement of General Routine Uses.

FAA Form 8130-15 (04-2015)

Previous editions obsolete

i

Form Approved
OMB No. 2120-0690
Exp.10/31/2018

Light-Sport Aircraft / Kit
Statement of
Compliance

INSTRUCTIONS - Print or type. If additional space is required,
use an attachment. Present original to an authorized FAA
Representative. Retain this form in the aircraft's permanent
records.

1. Manufacturer Name

2. Manufacturer Address (street, city, state, zip)

3. Country of Manufacture

4. Date of Manufacture

6. Aircraft Make

7. Aircraft Model

Check applicable items:
Airplane

First of Make or Model
Powered Parachute

5. Aircraft Serial No.

8. Max. Take-off Weight 9. V H

Aircraft (§21.190)

Weight-Shift-Control

Kit (§21.191(i)(2))
Glider

10. VS1

Operation on Water

Lighter-Than-Air

Gyroplane

FAA Applicable Accepted Standard(s) (with Dash Number)

Manufacturer's Documentation (with Revision and Issue Date)

11. Design and Performance

12. Design and Performance

13. Required Equipment

14. Required Equipment Listing

15. Quality Assurance

16. Manufacturer's Quality Assurance System

17. Production Acceptance Tests

18. Manufacturer's Production Acceptance Tests

19. Maintenance & Inspection Procedures

20. Aircraft Maintenance & Inspection Procedures

21. Continued Airworthiness

22. Manufacturer's Continued Airworthiness System

23. Manufacturer's Assembly Instructions

24. Manufacturer's Assembly Instructions (LSA Kit)

25. Power plant or Motor System

26. Power plant or Motor System

27. Flight Training Supplement

28. Aircraft Flight Training Supplement

29. Pilot's Operating Handbook/Aircraft Operating Instructions

30. Pilot's Operating Handbook/Aircraft Operating Instructions

Comments (additional comments may be stated on the reverse side of this form or an attached document)
I hereby certify that aircraft/kit serial number
as equipped, complies with the Title 14 of the Code of Federal Regulations
part 1, Definitions and Abbreviations, § 1.1 definition for light-sport aircraft, and the applicable portions of the consensus standards
identified on this statement of compliance for U.S. airworthiness certification. The manufacturer will monitor and correct safety-of-flight
issues through the issuance of safety directives and the manufacturer’s continued airworthiness system to support the aircraft
throughout its life. This aircraft/kit (1) was manufactured following the consensus standards procedures and manufacturer’s quality
assurance system identified on this statement, (2) conforms to the manufacturer’s design data, (3) was ground and flight tested
successfully [N/A for kit], and (4) is in a condition for safe operation [N/A for kit]. Additionally, at the request of the FAA the
manufacturer will provide unrestricted access to its facilities, and will make available to any interested person the aircraft’s operating
instructions, maintenance and inspection procedures, and flight training supplement.
I hereby certify that all statements and answers provided by me on this form are complete and true to the best of my
knowledge, and I agree that they are to be considered part of the basis for issuance of any FAA certificate.
Name:

Signature:

Title:

Date:

Name:

Signature:

Title:

FAA Form 8130-15 (05-2018

Date:

Previous editions obsolete

1

Form Approved
OMB No. 2120-0690
Exp.10/31/2018

FAA Form 8130-15 (05-2018)

Previous editions obsolete

2