\
Travis E. Lee
Slgnerurd
s)

and Tt rler s;

Owner
April 2, 1991

FOR FM USE ONLY

_-.-----
--------CT] APPROVED

0
a Pr~v~~i~rr~l
Pilot
khw1
Certificute
2
o
 Pilot School
CeHificme,
either with
13
DISAPPROVED orsociated ratings bring
the number
shown above is i
rsued
effective
1
ad
which explrer
on
.

n
Renew1
‘--
WI thout
ommdments
2
with amendments m
Amendments
.--
-e-v.

S I G NA TURE OF  APP(~OVINC
 OFF’CI
AL  TIT L E  DATE 

FAA Form 84ZQ-8
(4-741
Recommtndot,ons
of I
nspecTor(
I
1
on reverse
Figure 3. Application For Pilot School Certificate FRONT
AC 141~1A
Appendix 1

.
. .
INSTRUCTIONS TO THE APPLICANT:
Submu
t
an orIginal
and one
copy of this appli
cation,
comple:ed
in full,along
with the r~uired
number of uttochmmts
where
specified on rho
face
of
this
form, 10
rhe FAA District Office having iurisdictton
ovw
the oreo
in which the school is lOC0tCd.

Stgnoturer
on the opplicotlon
should be OS
foIIowr:

a.
Appl~cot~on
from a
person acting as
an individual should be signed by the owner;

b.
Appiicotlon
from Q
partnership
should
be signed by all partners;

C.
Application
from o corporation should be signed by the president or
such other officers OS
authorized
by the corpaotion
by-lows
to
sign
for the corporation
and certified
to by the corporate secretory attesting to
the authority
of the individuolr
to
sign such o

document;

d.  Appllcotion
from o company, club, or ossoctotlon
should be signed
by the prestdent
or such other or director os
authorized by
the orgonirotlon’s
by-laws, and
attested to by the5ecretary.

NOTE:
W~C~C
examining
ovthwiry
for
o
COUK
is
ksid,
place
on
‘X’
in
the

I3ENTIFICATION
 OF TRAINING COURSES
(Continud)

idtntifiicotion.

box
odjoccnt
 to the course
idtntificotion

rl

rl

13

III

III 
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