OMB Control No. 2120-0042
Exp. 11/30/2014
Paperwork Reduction Act Statement: The information collected on this form is necessary to ensure applicant eligibility. The
information is used to determine that the applicant meets the necessary qualifications as owner of an amateur built aircraft. We
estimate that it will take approximately 30 minutes to complete the form. The information collection is required to obtain a benefit. The
information collected becomes part of the aircraft registration system. Please note that an agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. OMB 2120-
0042. Comments covering the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at 800
Independence Avenue SW, Washington, DC 20591. ATTN: Information Collection Clearance Officer, AES-200.
AFFIDAVIT OF OWNERSHIP FOR AMATEUR-BUILT AND OTHER
NON-TYPE CERTIFICATED AIRCRAFT
(does not include light-sport)
U. S. Identification
Name of Amateur / Non TC’d builder
Model
Serial Number
Class (airplane, rotorcraft, glider, weight shift
control, powered-parachute, etc.)
Type of Engine Installed (reciprocating, turboprop, 2 or 4 cycle, electric, etc.)
Manufacturer, Model and Serial Number of each Engine Installed
Number of Engines Installed
Built for Land or Sea Operation
Number of Seats
MUST CHECK ONE
More than 50% of the above-described aircraft was built from miscellaneous parts and I am the owner. (This option is for aircraft
eligible for amateur-built certification.)
More than 50% of the above-described aircraft was built from a kit (prefabricated parts) and I am the owner. The bill of sale from
the kit manufacturer is attached. (This option is for aircraft eligible for amateur-built certification.)
I certify that the above-described aircraft is a newly built non-type certificated aircraft and is not currently registered in another
country. (This option is for aircraft eligible for experimental certification other than amateur-built.)
I certify that the above-described aircraft is a previously built (used) non-type certificated aircraft and is not currently registered in
another country. (This option is for aircraft eligible for experimental certification other than amateur-built certification.)
Evidence of ownership from the aircraft builder through any intervening owners is attached (chain of ownership).
Unable to obtain complete chain of ownership. Statement as to ownership history and whereabouts of aircraft is attached.
Name of Owner:
Title of Signer
Signature of Owner:
(If Appropriate):
Address:
City:
State:
Zip:
Telephone:
Notary Public:
State of:
County of:
Subscribed and sworn to before me this
day of
,
My Commission Expires:
(Signature of Notary Public)
AC Form 8050-88 (03/12)