f~ FonnApproved IElectronicTrackingNumberOMS No. 2120-0020

MAJOR REPAIR AND AL TERA TION 212812011US Department ForFAAUse Onlyof Transportation (Airframe, Powerplant, Propeller, or Appliance)FederalAviationAdministration -- -INSTRUCTIONS: Print or type all entries. See Title 14 CFR §43.9, Part 43 Appendix B, and AC 43.9-1 (or subsequent revision thereof) forinstructions and disposition of this form. This report is required by law (49 U.S.C. §44701). Failure to report can result in a civil penalty for eachsuch violation. (49 U.S.C. §46301{a»

Nationality and Registration Mark Serial No.

1. AircraftN3129E 7AC-6726Make Model /,Series

Aeronca 7AC-Conv ChampionName (As shown on registration certificate) Address (As shown on registration certificate)

AddressRR 3 Box 24 A2. Owner City Elizabeth State VIN

Propst, John E and Barbara J Zip 26143-9319 CountryUSA

3. For FAA Use On Iv

""i'tz! ~icai ~te ideGfCiW•• b.u ~ fu~ ~ oomply wiiih*a~bk abwonhideG~Md is~ approt'ed!crulli': cniy~ the above descnlled aircraft, INbjrd to conformity inspection~ • J!CI'iIOl'l in ~:U." . ~ ,.!:/c-~;/o...,Q~~CG//;, '1¢ __Date Signatureof FAA ~or. AEA·FSOO-07

4. Type 5. Unit Identification

Repair Alteration Unit Make Model Serial No.

D 0 AIRFRAME (As described in Item 1above)

0 0 POWERPLANT

0 0 PROPELLER

Type

0 0 APPLIANCE Manufacturer

6. Conformity Statement

A Agency's Name and Address B. Kind of AgencyName C William pancake JR ./ u. S. CertifICatedMechanic I ManufacturerAddress RR 4 Box 218 ForeignCertificatedMechanic C. Certificate No.City Keyser stateVl/V Certiflcatec RepairStation --Zip 26726 CountryUSA CertificatedMaintenanceOrganization A&P 2228906

D. I certify that the repair and/or alteration made to the unit(s) identified in item 5 above and described on the reverse or attachments heretohave been made in accordance with the requirements of Part 43 of the U.S. Federal Aviation Regulations and that the informationfurnished herein is true and correct to the best of my knowledge.

Extended range fuel Signature/Date of Authorized Individual

per 14 CFR Part 43 0 c.#t-I~fJ- e aAO 25 MAY 2010App.B

7. Approval for ReturMo Service

Pursuant to the authority given persons specified below, the unit identified in item 5 was inspected in the manner prescribed by theAdministrator of the Federal Aviation Administration and is G Approved o Rejected

FAA Fit Standards Manufacturer Maintenance Organization I PersonsApproved by CanadianInspector Department of Transport

BY Other (Specify)FAA Designee Repair Station .f Inspection Authorization

Certificate or Signature/Date of Authorized Individual, Designation No.t

IA2228906 C 'h./~ --Pcvxed.& j;,. 25 MAY 2010FAA Form 337 (10-06)

NOTICE

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

8. Description of Work Accomplished(If more space is reql'Jired,attach additional sheets. Identify with aircraft nationaJio'and registrationmark and date work completed.)

IN3129E 1125 May 2010

Nationalityand RegistrationMark Date

ELT EBC102A, Sn 45405 was installed in this aircraft at some unknown previous time. Following aircraft restoration,the ELT EBC 102A, WT 1.2 Ibs, Sn 45405 was reinstalled. It is bracket mounted to left fuselaqe tube #28 at +57" aft ofdatum.

Instruction for Continued Airworthiness1. Introduction: See Above.2. Description: Installation of Emergency locator Transmitter in accordance with FAR Section 91.2073. Control: N/A "1-'.'

4. Service Information: Service'EL Tin aecoraarice"wlth FAR 'SeC(iO'n"'91:20'1'seCfioh'O}'i;· •...5. Maintenance Instruction: Maintain in accord~nCewitl';--EBt rriaIHte'naIW:e'·in'StrUqio~S,.,.., ,6. Trouble Shooting Information: Test switch can beactivat~d ma~LJaUyorby bumping the unit to test7. Removal and placement Information: Remo",~I>(.')fELJ;'sh::l(!,p.~\dpn~;jnapFDrdancewit~,tbe requirements of FAR91.207 Section F. -. . ... .....,.. '. ."

8.. Diagrams: NlA9. Spedal Inspection Requirements: N/A10. Application of Protective Treatment N/A11. Data: N/A12. List of Special Tools: N/A13: For Commuter Category Aircraft: N/A14. Recommended Overhaul Period: N/A15. Airworthiness limitation Section: N/A16. Revision: N/A

END

o Additional Sheetl1 Are Attached

FAA Form 337 (10-06)