US Department
 of Transportation

Federal Aviation
Administration	
MAJOR REPAIR AND ALTERATION
(Airframe, Powerplant, Propeller, or Appliance)	Form Approved
OMB No. 2120-0020
For FAA Use Only
Office Identification	
INSTRUCTIONS:  Print or type all entries.  See FAR 43.9 Appendix B, and AC 43.9-1 (or subsequent revision thereof) for instructions and disposition of this form.  This report is required by law (49 U.S.C. 1421).  Failure to report can result in a civil penalty not to exceed $1,000 for each such violation (Section 901 Federal Aviation Act of 1958).	

1. Aircraft

	Make
	     
Serial No.
	     	Model
	     
Nationality and Registration Mark
	     	

2. Owner

	Name (As shown on registration certificate)

	     
	     	Address (As shown on registration certificate)

	     
	     	
3. For FAA Use Only
	
4. Unit Identification	5. Type	

Unit	
Make	
Model	
Serial No.	
Repair	
Alteration	

AIRFRAME
	
~~~~~~~~~~ (As described in Item 1 above) ~~~~~~~~~~	
     	
     	

POWERPLANT
	
     	
     	
     	
     	
     	

PROPELLER
	
     	
     	
     	
     	
     	

APPLIANCE

	Type

	     
Manufacturer

	     	

     	

     	

     	

     	
6. Conformity Statement	
A. Agency’s Name and Address	B. Kind of Agency	C. Certificate No.	

	     
	     
	     
	 
 
 
 	U.S. Certified Mechanic
Foreign Certified Mechanic
Certificated Repair Station
Manufacturer

     	
D.	I certify that the repair and/or alteration made to the unit(s) identified in item 4 above and described on the reverse or attachments hereto have been made in accordance with the requirements of Part 43 of the U.S. Federal Aviation Regulations and that the information furnished herein is true and correct to the best of my knowledge.	
Date
	     
	Signature of Authorized Individual	
7. Approval for Return to Service	
Pursuant to the authority given persons specified below, the unit identified in item 4 was inspected in the manner prescribed by the 
Administrator of the Federal Aviation Administration and is	  APPROVED	  REJECTED	

BY

 

 
	
FAA Flt. Standards Inspector

FAA Designee	
 

 	
Manufacturer

Repair Station	
 

 	
Inspection Authorization

Person Approved by Transport Canada Airworthiness Group
	Other (Specify)

     	
Date of Approval or Rejection

     	Certificate or
Designation No.
     	Signature of Authorized Individual	
FAA Form 337 (12-88)
NOTICE

Weight and balance or operating limitation changes shall be entered in the appropriate aircraft record.  An  alteration must be compatible with all previous alterations to assure continued conformity with the applicable airworthiness requirements.

B.	Description of Work Accomplished
	(If more space is required, attach additional sheets, Identify with aircraft nationality and registration mark and date work accomplished.)

     
     
     
     
     
     
     
     
	
 Additional Sheets Are Attached	
 U.S. G.P.O  1990-761-753