Free Authorized Release Certificate - Federal


File Size: 186.1 kB
Pages: 1
File Format: PDF
State: Federal
Category: Government
Author: AIR230DB
Word Count: 293 Words, 2,078 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://forms.faa.gov/redirect.asp?fnumber=8130-3&url=forms/faa8130-3.pdf

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1. Approving National Aviation Authority/Country:

2.

3. Form Tracking Number:

AUTHORIZED RELEASE CERTIFICATE
FAA Form 8130­3, AIRWORTHINESS APPROVAL TAG
5. Work Order/Contract/Invoice Number: 8. Part Number: 9. Eligibility: * 10. Quantity: 11. Serial/Batch Number: 12. Status/Work:

4. Organization Name and Address:

6. Item:

7.

Description:

13. Remarks:

14. Certifies the items identified above were manufactured in conformity to: Approved design data and are in a condition for safe operation. Non-approved design data specified in Block 13.

19.

14 CFR 43.9 Return to Service

Other regulation specified in Block 13

Certifies that unless otherwise specified in Block 13, the work identified in Block 12 and described in Block 13 was accomplished in accordance with Title 14, Code of Federal Regulations, part 43 and in respect to that work, the items are approved for return to service. 20. Authorized Signature: 21. Approval/Certificate No.:

15. Authorized Signature:

16. Approval/Authorization No.:

17. Name (Typed or Printed):

18. Date (m/d/y):

22. Name (Typed or Printed):

23. Date (m/d/y):

User/Installer Responsibilities
It is important to understand that the existence of this document alone does not automatically constitute authority to install the part/component/assembly. Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in Block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts parts/components/assemblies from the airworthiness authority of the country specified in Block 1. Statements in Blocks 14 and 19 do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown. FAA Form 8130­3 (6­01) *Installer must cross-check eligibility with applicable technical data. NSN: 0052-00-012-9005