DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION
THIS FORM SERVES TWO PURPOSES
PART I acknowledges the recording of a security conveyance covering the collateral shown.
PART II is a suggested form of release, which may be used to release the collateral from
the terms of the conveyance.
PART I CONVEYANCE RECORDATION NOTICE
NAME (last name first) OF DEBTOR
NAME and ADDRESS OF SECURED PARTY/ASSIGNEE
NAME OF SECURED PARTY’S ASSIGNOR (if assigned)
FAA REGISTRATION NUMBER
AIRCRAFT SERIAL NUMBER
AIRCRAFT MFR. (builder) and MODEL
ENGINE MFR. and MODEL
ENGINE SERIAL NUMBER(S)
PROPELLER MFR. and MODEL
PROPELLER SERIAL NUMBER(S)
THE SECURITY CONVEYANCE DATED ________________________ COVERING THE ABOVE COLLATERAL WAS
RECORDED BY THE FAA CIVIL AVIATION REGISTRY ON ________________________________ AS CONVEYANCE
NUMBER ____________________________.
PART II – RELEASE – (This suggested release form may be executed by the secured party and returned to the Civil Aviation Registry when the terms of
the conveyance have been satisfied.)
THE UNDERSIGNED HEREBY CERTIFIES AND ACKNOWLEDGES THAT THEY ARE THE TRUE AND LAWFUL HOLDER OF
THE NOTE OR OTHER EVIDENCE OF INDEBTEDNESS SECURED BY THE CONVEYANCE REFERRED TO HEREIN ON THE
ABOVE DESCRIBED COLLATERAL AND THAT THE SAME COLLATERAL IS HEREBY RELEASED FROM THE TERMS OF
THE CONVEYANCE. ANY TITLE RETAINED IN THE COLLATERAL BY THE CONVEYANCE IS HEREBY SOLD, GRANTED,
TRANSFERRED, AND ASSIGNED TO THE PARTY WHO EXECUTED THE CONVEYANCE, OR TO THE ASSIGNEE OF SAID
PARTY IF THE CONVEYANCE SHALL HAVE BEEN ASSIGNED; PROVIDED, THAT NO EXPRESS WARRANTY IS GIVEN NOR
IMPLIED BY REASON OF EXECUTION OR DELIVERY OF THE RELEASE.
DATED THIS ____________ DAY OF ___________________________________________________, ____________________.
_______________________________________________________________________________
_______________________________________________________________________________
(Name of security holder)
SIGNATURE IN INK ________________________________________________ TITLE ____________________________
ACKNOWLEDGMENT ( If required By Applicable Local Law):
Form Provided Courtesy of Aero-Space Reports, Inc.