EFTA00085967 # UNITED STATES OF AMERICA – DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION – MIKE MONRONEY AERONAUTICAL CENTER AIRCRAFT REGISTRATION APPLICATION 1) UNITED STATES REGISTRATION NUMBER N 722JE 2) AIRCRAFT MANUFACTURER AND MODEL KEYSTONE HELICOPTER S-76C 3) AIRCRAFT SERIAL NUMBER 760750 4) TYPE OF REGISTRATION (Check one box) □ 1. Individual □ 2. Partnership □ 3. Corporation □ 4. Co-Owner □ 5. Government □ 7. Limited Liability Company (LLC) □ 8. Non-Citizen Corporation □ 9. Non-Citizen Corporation Co-Owner 5) NAME(S) OF APPLICANT(S) [Person(s) shown on evidence of ownership. If individual, give last name, first name and middle initial.] Industrial Integrity Solutions, LLC 6) TELEPHONE NUMBER ( ) 7) MAILING ADDRESS (Permanent mailing address for first applicant on list.) NUMBER AND STREET: ___ RURAL ROUTE: ___ P.O. BOX ___ CITY: ___ STATE: ___ ZIP: ___ 8) PHYSICAL ADDRESS/LOCATION IF PO BOX, MAIL DROP OR RURAL ROUTE BOX USED FOR MAILING ADDRESS NUMBER AND STREET: ___ DESCRIPTION OF LOCATION ___ CITY: ___ STATE: ___ ZIP: ___ ## 10) CERTIFICATION (1) That the above aircraft is owned by the undersigned applicant who is: (MUST CHECK ANDIOR COMPLETE a, b, c, or d) a. A citizen of the United States as defined by 49 USC 40102(a)(15); b. A resident alien with alien registration (Form 1-551) No. c. A non-citizen corporation organized and doing business under the laws of (state) and said aircraft is based and primarily used in the United States. Records of flight hours are available for inspection at [provide complete physical address] d. A corporation using a voting trust to qualify. Enter name of trustee (2) If box c or d above is checked, I, the below signed, certify that I am authorized, by the applicant shown above, to sign corporate documents and to (3) That the aircraft is not registered under the laws of any foreign country, and (4) That legal evidence of ownership is attached or has been filed with the Federal Aviation Administration. | I/we hereby certify that the information provided in, and in any attachments to, this application for aircraft registration is true, accurate and correct to the best of my/our knowledge and belief. I/we understand that the FAA administrator will rely on the information I/we provide in determining my/our qualification for aircraft registration. I/we understand that whoever, in any matter within the jurisdiction of any department or agency of the United States, knowingly and wilfully falsifies, conceals, or covers up by any trick, scheme, or device any material fact(s), statement(s), representation(s) or entry(ies) may be fined up to $500,000 or imprisoned for not more than five (5) years or both (18 U.S.C. §§ 1001 and 3571). I/we understand that to knowingly and willfully: a) falsify or conceal a material fact; or b) use a document knowing it contains a false, fictitious or fraudulent statement/entry; or c) provide any inaccurate, false statement/information subject me to criminal prosecution (49 U.S.C. § 46306), and the registration of the subject aircraft may be delayed, denied and/or revoked. NOTE: If executed for co-ownership, all applicants must sign. Use next page and add page(s) if necessary.
11)SIGNATURE: Digitally signed by RICHARD MUNKVOLD id.L7wsUllUsFLu1nEahgqwKfS474sWDATE: 5-13-2021
TYPED/PRINTED NAME: Richard MunkvoldTITLE: CFO of Frontier Finance Co its Member
12)SIGNATURE:DATE:
TYPED/PRINTED NAME:TITLE:
NOTE: Except when the most recent registration of the subject aircraft is expired or cancelled, 14 CFR 47.31(c) provides for an airworthy U.S. aircraft to be operated for up to 90 days within the United States when a copy of the signed aircraft registration application is carried in the aircraft while awaiting issuance and receipt of the new registration certificate. AC Form 8050-1 (02/20) Page 1 |