**OMB NO. XXXX-XXX**

**EXPIRATION DATE: MM/DD/YYY**

**Public Burden Statement**

**A federal agency may not conduct or sponsor, and a person is not
required to respond to, nor shall a person be subject to a penalty for
failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of
information displays a current valid OMB Control Number. The OMP Control
Number for this information is XXXX-XXXX. Public reporting for this
collection of information is estimated to be approximately (480) minutes
per response, including the time for reviewing instructions, gathering
the data needed, and completing and reviewing the collection of
information. All responses to this collection of information are
voluntary. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden to: Information Collection Clearance Officer,
Department of Transportation, 400 7^th^ Street, SW, Washington DC,
20590.**

**Application Form for Reimbursement under**

**Section 185 of Public Law 109-115**

1\. Applicant name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. Applicant address:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. At which of the following airports did the applicant operate as a
fixed-based operator or provider of general aviation ground support
services during the eligible period for reimbursement?

-   Ronald Reagan Washington National Airport

-   College Park Airport in College Park, Maryland

-   Potomac Airfield in Fort Washington, Maryland

-   Washington Executive/Hyde Field in Clinton, Maryland

-   Washington South Capitol St. Heliport, Washington, D.C.

4\. Briefly describe the nature of the applicant's operations as a
fixed-based general aviation operator or a provider of general aviation
ground support services at each airport during the eligible period for
reimbursement.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. Did the applicant or any part of it conduct non-fixed-based general
aviation activities or provide non-aviation ground support services
during the 2001 through 2005 period?

Yes. Briefly describe the non-fixed-based general aviation activities
and non-aviation ground support services.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

No.

6\. Briefly describe how the events of September 11, 2001 affected the
applicant's operations as a fixed-based general aviation operator or a
provider of general aviation ground support services.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7\. In response to the events of September 11, 2001, did the applicant
take any action to lessen or offset the impact of those events?

Yes. Briefly describe those actions and the effect they had on the
applicant.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

No.

8\. Has the applicant filed income taxes for any period between 1999 and
2005?

Yes. Specify the filing status under which the applicant filed
(corporation, partnership, sole proprietorship, etc.?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

No.

9\. Baseline Financial Data and Forecasts. Attach to this Appendix
copies of your profit and loss statements, or such financial records as
you generated as a routine matter for the use of management, for the
periods 1999 through 2005, that show your actual financial results.
Similarly, attach copies of any actual forecasts that you prepared for
both these baseline periods and for any part of the reimbursement
periods that were prepared prior to September 11, 2001.

10\. The requested amount of reimbursement claimed below must be based
on a comparison of actual operating results (revenues, expenses and
profits or losses), adjusted as indicated, with a similarly adjusted
company forecast/budget of operating results that existed prior to
September 11, 2001 if such a forecast/budget was actually prepared. If
the applicant did not prepare any such pre-September 11 forecasts, or
prepared them for less than the full reimbursement period, an
after-the-fact estimate of what the applicant can document it reasonably
expected to earn during the remaining eligible period may be submitted.
If such an after-the-fact estimate is used, describe below the period
for which it applies and the methodology that was used to determine it.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11\. Reimbursement Claim

+-----+-------------------+-------------+--------------+-------------+
| Fin |                   |             |              |             |
| anc |                   |             |              |             |
| ial |                   |             |              |             |
| D   |                   |             |              |             |
| ata |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
|     |                   | Column A    | Column B     | Column C    |
+-----+-------------------+-------------+--------------+-------------+
|     |                   | Pre 9-11-01 | > Actual     | Column A    |
|     |                   | Forecast or | > Results    |             |
|     |                   | Aft         | > for the    | Minus       |
|     |                   | er-the-Fact | > Eligible   | Column B    |
|     |                   | Estimate    | > Period\*   |             |
|     |                   | for the     |              |             |
|     |                   | Eligible    |              |             |
|     |                   | Period\*    |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Total Operating   |             |              |             |
| ine | Revenues          |             |              |             |
| 1   |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Total Operating   |             |              |             |
| ine | Expenses          |             |              |             |
| 2   |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Operating Profit  |             |              |             |
| ine | or (Loss)         |             |              |             |
| 3   |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Nonoperating      |             |              |             |
| ine | Revenue           |             |              |             |
| 4   |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Nonoperating      |             |              |             |
| ine | Expenses          |             |              |             |
| 5   |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Nonoperating      |             |              |             |
| ine | income(loss)      |             |              |             |
| 6   | before taxes      |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| L   | Professional      |             |              |             |
| ine | Application Fee   |             |              |             |
| 7   | (@80%, max.       |             |              |             |
|     | \$2000)           |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| To  | Adjusted Income   |             |              |             |
| tal |                   |             |              |             |
|     | Line 3 plus line  |             |              |             |
|     | 6 and line 7 in   |             |              |             |
|     | the last column   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+
| The |                   |             |              |             |
| ta  |                   |             |              |             |
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| ab  |                   |             |              |             |
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| -02 |                   |             |              |             |
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| 1   |                   |             |              |             |
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| mns |                   |             |              |             |
| A   |                   |             |              |             |
| and |                   |             |              |             |
| B.  |                   |             |              |             |
+-----+-------------------+-------------+--------------+-------------+

12\. Has the applicant or any of its subsidiaries or affiliates received
grants, subsidies, incentives or similar payments from local, state, or
Federal governmental entities in support of the security, maintenance
and provision of general aviation services and facilities furnished in
response to the events of September 11, 2001? (This includes payments
under the Aviation Transportation Security Act (ATSA) Public Law 107-71
November 19, 2001, and the Airport Improvement Program (AIP)).

Yes. Enter amount = \$\_\_\_\_\_\_\_\_\_\_\_\_\_

No

13\. Has the applicant or any of its subsidiaries or affiliates incurred
lobbying expenses, mitigating expenses, or special expenses (as
described in the section captioned "What information must operators or
providers submit in their applications for reimbursement?"), or
extraordinary, non-recurring, or unusual adjustments?

Yes. Briefly describe these expenses and the amount of each, and state
if they have been included in or excluded from the totals in the table
at item number11.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

No

14\. Certification

I certify the above information and all attached documents as true and
accurate under penalty of law, and acknowledge that falsification of
information may result in prosecution and imposition of a fine and/or
imprisonment.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of Company Official (must be President, CEO, COO, or CFO)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Printed Name of Company Official

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Position (President, CEO, COO, or CFO) of Company Official

Phone Number of Company Official: (voice)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(fax)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Contact Person (if different from above)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Position of Contact Person (if different from above)

Phone Number of Contract Person: (voice)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(fax)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Email Address of Contact
Person:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Instructions for Completing Application Form for Reimbursement under**

**Section 185 of Public Law 109-115**

1.  **Applicant name**

> This is the person or legal entity who undertakes to act as a
> fixed-based general aviation operator or who provides general aviation
> ground support services, directly or by a lease or any other
> arrangement.

2.  **Applicant address**

> The applicant address is that location within the local tax authority
> jurisdiction that is held out to the public as the business or airport
> address.

3.  **Airport of operation on September 11, 2001**

> This question asks the applicant to identify those airports in the
> Washington, D.C. area where it provided either fixed-based general
> aviation services or general aviation ground support services on
> September 11, 2001. Check as many airports as you served on September
> 11, 2001.

4.  **Briefly describe the nature of the applicant's operations as a
    fixed-based general aviation operator or a provider of general
    aviation ground support services at each airport during the eligible
    period for reimbursement.**

> You should describe the specific fixed-based general aviation services
> or general aviation ground support services that you provided at each
> of the airports.

5.  **Did the applicant or any part of it conduct non-fixed-based
    general aviation activities or provide non-aviation ground support
    services during the 2001 through 2005 period?**

> Check "Yes" if you conducted any non-fixed-based general aviation
> activities or provided non-aviation ground support services during the
> 2001 through 2005 period. Describe the activities that you undertook
> during this period that did not directly support general aviation at
> the airport.

6.  **Briefly describe how the events of September 11, 2001 affected the
    applicant's operations as a fixed-based general aviation operator or
    a provider of general aviation ground support services.**

> You should describe how the level and conduct of your operations as a
> fixed-based general aviation operator or your operations as a provider
> of general aviation ground support services were changed as a result
> of September 11 2001 and the ensuing security restrictions that were
> imposed by the Federal Government.

7.  **Did the applicant undertake any actions to lessen or offset the
    impact of the Federal Government's closure of airports in the
    Washington, D.C. area following the attacks of September 11, 2001?**

> Check "Yes" is you attempted to minimize the impact that the terrorist
> attacks of September 11, 2001, had on your business. Briefly describe
> your actions and the effect that they had on you. Include any
> activities or services undertaken after September 11, 2001 that did
> not provide support for general aviation but that did provide revenues
> to sustain your business.

8.  **Has the applicant filed income taxes for any period between 1999
    and 2005?**

> Check "Yes" if you filed income taxes during this period, and indicate
> the filing status under which you filed your income tax returns.

9.  **Baseline Financial Data and Forecasts. Attach to this Appendix
    copies of your profit and loss statements, or such financial records
    as you generated as a routine matter for the use of management, for
    the periods 1999 through 2005, that show your actual financial
    results. Similarly, attach copies of any actual forecasts that you
    prepared for both these baseline periods and for any part of the
    reimbursement periods that were prepared prior to September 11,
    2001.**

> This question directs applicants to provide the Department with
> certain financial documents in order to verify and substantiate their
> claims. Documents that you have already prepared should be sufficient.
> When necessary, you should supplement these documents with footnotes
> or explanations that are pertinent to your reimbursement claim. The
> financial data may include such documents as income statements,
> statements of operations, forecasts of operating results, income
> projections, pro forma budget projections, budget documents, tax
> preparation support material, information presented in investment
> perspectives and registrations, or other similar information that in
> whole or in part cover the period from 1999 through 2005.

10. **The requested amount of reimbursement claimed below must be based
    on a comparison of actual operating results (revenues, expenses and
    profits or losses) (adjusted as shown), with a similarly adjusted
    company forecast of operating results that existed prior to
    September 11, 2001 if such a forecast was actually prepared. If the
    applicant did not prepare any such pre-September 11 forecasts, or
    prepared them for less than the full reimbursement period, an
    after-the-fact estimate of what the applicant can document it
    reasonably expected to earn during the remaining eligible period may
    be submitted. If such an after-the-fact estimate is used, describe
    below the period for which it applies and the methodology that was
    used to determine it.**

> Indicate here whether an "after-the-fact" forecast was prepared, and
> briefly describe the methodology used in preparing the forecast. Your
> methodology must take into account items relevant to your businesses,
> such as the terms of existing contracts, short-term or long-term
> budget documents, documents submitted in support of applications for
> loans or lines-of-credit, existing labor agreements and leasing
> agreements, and other similar types of documents.
>
> In preparing your "after-the-fact" forecast, you may wish to consult a
> July 2001 report prepared for the FAA, entitled *Forecasting Aviation
> Activity by Airport*. This report was prepared by GRA, Incorporated
> (GRA), for the FAA's Office of Aviation Policy Plans Statistical and
> Forecast Branch (APO-110). While the Department recognizes that fixed
> based general aviation operators and providers of general aviation
> ground support services are different entities than larger airports at
> which scheduled service is provided, the Department believes that this
> document offers relevant guidance to applicants who do not prepare
> forecasts as part of regular business operations. This July 2001
> report may be accessed at:
> <http://www.faa.gov/data_statistics/aviation_data_statistics/forecasting/media/AF1.doc>.
>
> The July 2001 report explains the basic steps usually utilized in
> preparing forecasts, including: identifying parameters and measures to
> forecast; collecting forecast information of expected revenues or
> expenses, including budgets; gathering and evaluating data; selecting
> a forecast method (such as regression and trend analysis, share
> analysis, or exponential smoothing); applying methods and evaluating
> results; and summarizing and documenting the results.
>
> Additionally, data sources to assist you in making adjustments to your
> forecast are available from the Department's web site at
> <http://ostpxweb.dot.gov/aviation/index.html> (Click on "Programs" and
> scroll down to "General Aviation Operator and Service Provider
> Reimbursement"). The Department notes that, while it can answer
> questions for applicants that might arise while applicants develop
> forecasts, the Department is not in a position to propose or develop
> projections for applicants.

11. **Reimbursement Claim**

> For purposes of completing the information in the reimbursement claim
> table, total operating revenues (line 1) include the inflow of funds
> to the applicant resulting from the sale of goods and services related
> to the activities of a fixed-based operator or a provider of general
> aviation services. Examples include, but are not limited to monetary
> amounts or value received for providing: aircraft fuel or oil;
> delivery of aircraft fuel or oil; transient and long-term storing, tie
> down parking and sheltering of aircraft; maintenance, inspection,
> checking, upgrading of aircraft and aircraft related equipment and for
> polishing and cleaning property and equipment; for providing flight
> instruction services and materials; and miscellaneous items for
> purchase such as maps, books, flight clothing, sectional charts,
> devices and parts for aircraft, food services, hospitality services,
> auto rentals, aircraft custodial and sanitation services, assistance
> grants from state and Federal government agencies, insurance payments,
> and revenues derived from the business activities conducted at
> alternative airports to those that were closed.
>
> .
>
> Total operating expenses (line 2) include the cost to the applicant of
> providing the goods and services related to the activities of a
> fixed-based operator or a provider of general aviation services.
> Examples include, but are not limited to: labor costs for all
> categories of employees (including compensation, vacation and sick
> leave pay, medical benefits, workmen's compensation contributions,
> accruals or annuity payments to pension funds, training
> reimbursements, professional fees, licensing fees, educational or
> recreational activities for the benefit of the employee, stock
> incentives, etc.); the cost of fuel and oil including nonrefundable
> aircraft fuel and oil taxes; insurance; flight and ground equipment
> parts; general services purchased for flight or ground equipment
> maintenance; depreciation of flight and ground equipment; amortization
> of capitalized leases for flight and ground equipment; provisions for
> obsolescence and deterioration of spare parts; insurance premiums; and
> rental expenses of flight and ground equipment expenses associated
> with business activities conducted at alternative airports to those
> that were closed. Advertising, promotion and publicity expenses,
> landing fees, clearance, customs and duties, utilities, bookkeeping,
> accounting, recordkeeping and legal services are also part of the
> total operating expenses.
>
> Operating Profit or loss is calculated by subtracting the total
> operating expenses from the total operating revenues. If the total
> operating revenues exceed the total operating expenses, the
> calculation results in an operating profit. If the total operating
> expenses exceed the total operating revenues, the calculation results
> in an operating loss.
>
> Nonoperating income and expenses include: income and loss incident to
> commercial ventures not inherently related to the direct provision of
> fixed-based operator services or general aviation ground support
> services; other revenues and expenses attributable to financing or
> other activities that are extraneous to and not an integral part of
> general aviation services; and special recurrent items of a nonperiod
> nature.
>
> Examples of non-operating income include, but are not limited to:
> interest income; foreign exchange gains; equity investment in an
> investor controlled company; intercompany transactions; dividend
> income; and net unrealized gains on marketable equity securities.
>
> Examples of nonoperating expenses include, but are not limited to:
> interest on long-term debt and capital leases; interest on short-term
> debt; imputed interest capitalized; amortization of discount and
> expense on debt; foreign exchange losses; fines or penalties imposed
> by governmental authorities; costs related to property held for future
> use; donations to charities, social and community welfare purposes;
> losses on reacquired and retired or resold debt securities; and losses
> on uncollectible non-operating receivables.
>
> For reasons set forth elsewhere in section 331.7 of this Part, you may
> not include lobbying expenses that were incurred to promote
> reimbursement for losses after the terrorist attacks or enact Section
> 185 of P.L. 109-115. .
>
> Nonoperating income is the result of subtracting the non-operating
> expenses from the non-operating revenues.
>
> Professional application fees provide for reimbursement of 80 percent
> of the cost of professional accounting services required in the
> preparation and submission of the application.
>
> Adjusted Income for each of the Columns A and B is the sum of the
> Operating profit (or loss)(line 3) plus line 6, Non-operating income
> (loss). Each line of Column C is the result of subtracting Column B
> from Column A, except on line 7, Professional Application Fees, where
> the claimant may enter 80 percent of professional application fees (up
> to a maximum of \$2,000). The Adjusted Income figure on the Total line
> of Column C represents the amount claimed as total reimbursement; it
> may of course be adjusted as the result of Department review.
>
> All Adjusted Income figures do not reflect taxes due in the current
> period, as a consequence, reimbursements will be pre-tax and income
> taxes may be due on reimbursed funds.
>
> The difference between column A and B is the basis for column C. This
> constitutes the total amount of your claim for reimbursement.
>
> As the eligibility periods, for the most part, begin and end on days
> other than the first or last days of the month, quarter or year, data
> from already existing financial statements must be adjusted, on a
> pro-rata basis, to reflect the eligibility periods. For example, the
> period of eligibility for all applicants begins on September 11, 2001
> and therefore, the only time period during the month of September that
> is eligible for reimbursement is September 11 through September 30, a
> period of 20 days. Applicants should be prepared to show both how they
> apportioned such financial data into the reimbursement periods, and
> why they chose the apportionment approach used. Applicants can then
> use these estimates for the specified periods at the beginning and end
> of the eligible period to add to the financial amounts for 2002, 2003,
> and 2004 to calculate the total amounts sought in Appendix A.

12. **Has the applicant or any of its subsidiaries or affiliates
    received grants, subsidies, incentives or similar payments from
    local, state, or Federal governmental entities in support of the
    security, maintenance and provision of general aviation services and
    facilities furnished in response to the events of September 11,
    2001? (This includes payments under the Aviation and Transportation
    Security Act of 2001 (Public Law 107-38) and the Airport Improvement
    Program under the Airport and Airway Improvement Act of 1982 (Public
    Law 97-248).)**

> This question requires that you disclose all grants, subsidies, or
> incentives that you received during the eligible reimbursement period,
> either directly or indirectly, from Federal, State, and local
> entities, to reimburse you for the cost of operations and capital
> improvements associated with implementing security programs, or
> maintaining or providing general aviation services and facilities.

13. **Has the applicant or any of its subsidiaries or affiliates
    incurred lobbying expenses, mitigating expenses, or special expenses
    (as described in the section captioned "What information must
    operators or providers submit in their applications for
    reimbursement?"), or extraordinary adjustments.**

> Check "Yes" if you incurred any such expenses or experienced any such
> adjustments. You must briefly describe the nature of such expenses and
> adjustments, including the amounts. Additionally, you must indicate
> whether or not such expenses or adjustments have been included in or
> excluded from the totals in the table at item number 11.
>
> Lobbying includes any amount paid to any person for influencing or
> attempting to influence an officer or employee of any agency, a Member
> of Congress, an officer or employee of Congress, or an employee of a
> Member of Congress.
>
> Mitigating expenses include the utilization of property, the provision
> of services and the sale of goods that were undertaken to mitigate
> losses arising from the Federal Government's closure of airports
> attendant to the September 11, 2001 attack. These could include
> expenses incurred for the provision of services and sale of goods
> moved from restricted airports to unrestricted airports or
> compensation for non-aviation oriented goods and services provided at
> restricted airports. Mitigating expenses may also include operating
> expenses for aviation-related fixed assets or capital utilized outside
> of the restricted airport.
>
> Special expenses include, but are not limited to, moving expenses,
> additional security equipment and facilities, and loss on sale of
> assets that arose from the direct imposition of restrictions during
> the period September 11, 2001 through the applicable eligible date.
> Any item reported as Special Expenses shall not also be expensed in
> other expense categories that are reflected in the calculation of the
> reimbursement claim. Details regarding special expenses should be
> noted in footnotes.
>
> Extraordinary adjustments are events or transactions that are material
> to your business and unusual in nature and infrequent in occurrence.

14. **Certification**

> You must certify that all information contained on the Background and
> Eligibility Form [and]{.underline} the documents submitted in support
> of your application (e.g. profit and loss statements, actual
> forecasts, after-the-fact forecasts, etc) are accurate. This
> certification is made under penalty of law. Falsification may be
> grounds for monetary and/or criminal sanctions. This certification
> must be made by a company President, CEO, COO, or CFO.