Sample Affidavit Of Ownership For Unmanned Aircraft
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1(must be notarized)
Sample
Affidavit of Ownership for Unmanned Aircraft
N-number: __________.
UA Class: □
Airship, □ Glider, □ Airplane, □ Rotorcraft, □ Hybrid Lift, □ Ornithopter
Manufacturer/Builder: _____________________________________. Model: ___________________.
(show full legal name of UA manufacturer or builder and UA model.)
Serial Number: ___________________________________. Max Takeoff Weight: ____________ lbs.
□ Electric; □ 2 Cycle Reciprocating; □ 4 Cycle Reciprocating; □ Turbo - Fan/Prop/Shaft/Jet
Engine Type:
Number of Engines:______.
The Undersigned Owner Certifies:
Select and complete one of these statements or compose a statement for your situation addressing these issues.
___1) I purchased the sUA described above as a new off-the-shelf item on
__________________
(date)
from the manufacturer or retail vendor named ________________________________________
located in
_______________________________________________________.
(city, state, country)
A manufacturer's bill of sale was not available at the time of purchase, and a receipt, invoice, or
other evidence is
□ enclosed □ not available to confirm the purchase.
(choose one)
___2) This UA described above was built from a prefabricated kit. The kit bill of sale from the manufacturer
to the undersigned or other evidence to prove the transaction is enclosed.
___3) This UA was built using miscellaneous parts.
___4) I purchased the used UA described above, the Bill of Sale signed by the seller is enclosed.
___5) I purchased the used UA described above from
(seller's full name)
________________________________
located in
___________________________________ on
_____________
(city, state, country)
(date)
The required bill of sale signed by the seller is not available because ______________________
_____________________________________________________________________________
_____________________________________________________________________________.
Other evidence such as a receipt or invoice is attached as proof that the transaction took place.
The undersigned affirms that the information and statements provided herein are correct, this UA
is not registered under the laws of any foreign country, and I am the rightful owner.
Owner's Name(s):_______________________________________________________________________________
Owner's Signature(s):___________________________________________________________________________
Printed Name of Signer(s):_______________________________________________________________________
_________________________________________________________________________
(if applicable)
Signer's Title:
--
State of: __________________ County of: __________________ Country:_________________
NOTARY PUBLIC
Subscribed and sworn before me this: ____ day of: _____________, ________
Signature: __________________________ My Commission Expires: _____________
(Notary Public or individual authorized under local law to administer oaths)
(Seal required if applicable in your State.)
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