Veterans Home Inspection Services LLC 

Henrey Dee Jetty 

28 Larchwood Drive 

Pittsford NY 14534 

Email: hjetty@rochest er.rr.com 

585-363-2848 (Call or text) 

NY Home Inspector Lie# 16000044801 

US Department Of Transportation 

Federal Aviation Administration 

Civil Aviation Registry 

Aircraft Registration Branch (AFS-750) 

PO Box 25504 

Oklahoma City, OK 73125-0504 

June 17, 2015 

Subject: Assignment of Registration Number for Exemption Application FAA Modernization and 

Reform Act of 2012 (Public Law 112-95). Section 333 of Public Law 112-95 

Reference: US DEPT of Transportation Memorandum dated June 5, 2015. Subject: Documents 

and Fees regarding DJI Phantom 2, serial number PH645440916. 

Dear Sir or Madam: 

I am providing the information that was requested for the registration of my DJI drone. I have 

contacted the offices of DJI the manufacturer of the drone. They do not provide a transfer slip 

or any form of title with the purchase of their drones. I am unable to provide a completed 

AC Form 8050-2, Aircraft Bill of Sale Information. I am providing notarized documents stating 

that I am the first owner ofthis drone (serial number PH645440916). I purchased the drone 

from a company (Drones ECT.) thru Amazon website. I am attaching all receipts that were 

provided during my purchase of the drone. Included is a picture of the drone and serial number. 

Pursuant to Section 333 of the FAA Modernization and Reform Act of 2012(the reform act) and 

CFR Part 11 Veterans Home Inspection Services LLC, is the owner and operator of a Small 

Unmanned Aircraft Systems (UASs). 

Please contact me if there is any additional information that is required. 

Sincerely 

COUNTY Of MONROE ss.: 

STATE OF NEW YORK} 

On this..tJ_day ot:ll.nt , 20.J5., before me, the 

subscriber, personally appeared Pine~ Qi~ to me 

personally known and known to me to I} the samef,erson 

de "bed in and who executed the within instrument and 

_ h cknowl ed hat _he_ executed ti:Je-instrument 

SARAH E. CLIMER 

Notary Public, State of New York 

No. 01CL6194707 

Qualified in Monroe County 

My Commission Expires 10/06/20 I~ 

. -

ary Public , · .:.:. -_ --- 2 -

: 

----- : ..... :: 
U.S. Department 

of Transportation 

Federal Aviation 

Administration 

June 5, 2015 

HENREY D JETTY 

28 LARCHWOOD DRIVE 

PITTSFORDNY 14534 

1 ... 11.1,,1,1.1 ... 11 .. 1 .. 1 •• 11.1 

Dear Mr. Jetty: 

Flight Standards Service 

Aircraft Registration Branch, AFS-750 

P.O. Box 25504 

Oklahoma City, Oklahoma 73125-0504 

(405) 954-3116 

Toll Free: 1-866-762-9434 

WEB Address: http://registry.faa.gov 

The Civil Aviation Registry has received the documents and fee concerning Dn PHANTOM 2, 

serial number PH645440916. United States identification number T0051638 has been 

temporarily assigned. The following is required before we can assign a registration number and 

registration of your amateur built aircraft can be completed. 

a. Submit a complete Affidavit of Ownership, signed before a notary public, and showing a 

description of the aircraft. The form attached to this letter meets our requirements and 

may be used if you wish. 

b. Submit documentary evidence of ownership (bill of sale, invoice, receipt, etc.) from the 

manufacturer through all intervening owners of the aircraft to you, OR, submit a written 

affidavit stating when, where and how the aircraft was purchased, and why the evidence 

of ownership cannot be provided. 

You can find additional information at the FAA website on how to register unmanned aircraft at 

(http://www.faa.gov/licenses_certificates/aircraft_certification/aircraft_registry/UAI) 

If you require further assistance, please contact the Aircraft Registration Branch at 

(405) 954-3116 or toll free 1-866-762-9434. 

Sincerely, 

MAURICE COLEMAN 

Legal Instruments Examiner 

Aircraft Registration Branch 

Enclosure: 8050-88 

AFS-700-LTR-1 (07/07) 
OMB Control No. 2120-0042 

Exp. 11/30/2014 

Paperwork Reduction Act Statement: The information collected on this form is necessary to ensure applicant eligibility. The 

information is used to determine that the applicant meets the necessary qualifications as owner of an amateur built aircraft. We 

estimate that it will take approximately 30 minutes to complete the form. The information collection is required to obtain a benefit. The 

information collected becomes part of the aircraft registration system. Please note that an agency may not conduct or sponsor. and a 

person is not required to respond to. a collection of information unless it displays a currently valid OMB control number. OMB 2120-

0042. Comments covering the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at 800 

Independence Avenue SW, Washington, DC 20591 . ATIN: Information Collection Clearance Officer, AES-200. 

AFFIDAVIT OF OWNERSHIP FOR AMATEUR-BUILT AND OTHER 

NON-TYPE CERTIFICATED AIRCRAFT 

(does not include light-sport) 

U.S. Identification T0051638 

----------------------------------------------------------------- Name of Amateur I Non TC' d builder DJ I Phantom 2 ---------------------------------------------------- Model Phantom 2 Version 3 Serial Number PH645440916 

Class (airplane, rotorcraft, glider, weight shift 

control, powered-parachute, etc.) Quadro-copter Drone (less than 4 lbs) 

Type of Engine Installed (reciprocating, turboprop, 2 or 4 cycle, electric, etc.) Electric (battery operated) 

Manufacturer, Model and Serial Number of each Engine Installed DJ I Phantom 2 Version 3 

---------------------------------------- Number of Engines Installed _4 ______________ _ 

Built for Land or Sea Operation land only Number of Seats N/A 

------------------- MUST CHECK ONE 

D More than 50% of the above-described aircraft was built from miscellaneous parts and I am the owner. (This option is for aircraft 

eligible for amateur-built certification.) 

D More than 50% of the above-described aircraft was built from a kit (prefabricated parts) and I am the owner. The bill of sale from 

the kit manufacturer is attached. (This option is for aircraft eligible for amateur-built certification.) 

0 I certify that the above-described aircraft is a newly built non-type certificated aircraft and is not currently registered in another 

country. (This option is for aircraft eligible for experimental certification other than amateur-built.) 

0 I certify that the above-described aircraft is a previously built (used) non-type certificated aircraft and is not currently registered in 

another country. (This option is for aircraft eligible for experimental certification other than amateur-built certification.) 

D Evidence of ownership from the aircraft builder through any intervening owners is attached (chain of ownership). 

0 Unable to obtain complete chain of ownership. Statement as to ownership history and whereabouts of aircraft is attached. 

Name of Owner: Henrey Dee Jetty 

Signature of Owner 

Address: 

City: Pittsford 

Telephone: 585-362-2848 

Notary Public: 

State of: N&.J'ioc K 

Subscribed and sworn to before me this 

AC Form 8050-88 (03/12) 

Title of Signer 

(If Appropriate): Home Inspector 

state: New York Zip: 14534 

County of: 

day of 0VY'le 

SARAH E. CLIMER 

Notary Public, State of New York 

No. 01 CL6194707 

Qualified in Monroe County 

My Commission Expires 10/00/21) & \t) 

ao15 

--
OMB Control No. 2120-0042 

Exp. 11/30/2014 

PRIVACY ACT STATEMENT: Privacy Act of 1974 (PL 93-579) requires that users of this form be informed of the 

authority which allows the solicitation of the information and whether disclosure of such information is mandatory or 

voluntary; the principal purpose for which the information is intended to be used; the routine uses which may be made 

of the information gathered; and the effects, if any, of not providing all or any part of the requested information. 

Title 49, United States Code requires the registration of each United States civil aircraft as a prerequisite to its 

operation. An aircraft is eligible for registration only: ( 1) if it is not registered under the laws of any foreign country; 

and (2) if it is owned by (a) a citizen of the United States; or (b) an individual citizen of a foreign country who has 

lawfully been admitted for permanent residence in the United States; or (c) a corporation lawfully organized and doing 

business under the laws of the United States or any State thereof so long as such aircraft is based and primarily used in 

the United States; or (d) a governmental unit. Operation of an aircraft that is not registered may subject the operator to a 

civil penalty. 

This form identifies the aircraft to be registered, and provides the name and permanent address for mailing the 

registration certificate. Incomplete submission will prevent or delay issuance of your registration certificate. 

The following routine uses are made of the information gathered: 

(1) To determine that aircraft are registered in accordance with provisions of the Title 49, United States Code. 

(2) To supportJ he investigative efforts oLFederal, State and foreign government law enforce nent agencies. 

(3) To serve as a repository oflegal documents used by individuals and title search companies to determine the 

legal ownership of an aircraft. 

(4) To provide aircraft owners and operators information about potential mechanical defects or unsafe 

conditions of their aircraft in the form of airworthiness directives. 

(5) To provide supporting information in court cases. 

(6) To serve as a data source for management information for production of summary descriptive statistics and 

analytical studies in support of agency functions for which the records are collected and maintained. 

(7) To respond to general requests from the aviation community or public for statistical information under the 

Freedom of Information Act or to locate specific individuals or specific aircraft for accident investigation, 

violation, or other safety related requirements. 

(8) To provide data for the automated aircraft registration master file. 

(9) To provide data for development of the aircraft registration statistical system. 

(10) To prepare an aircraft register in electronic media as required by ICAO agreement containing information 

on aircraft owners by name, address, N-Number, and type-aircraft, used for internal FAA safety program 

purposes and also available to the public (individuals, aviation organizations, direct mail advertisers, state 

and local governments, etc.) upon payment of applicable user charges reimbursing the Federal Government 

for its costs. 

(11) The aircraft records maintained by the Aircraft Registration Branch are public records and are open for 

inspection in Room 122 of the Registry Building, Mike Monroney Aeronautical Center, 6425 S Denning, 

Oklahoma City, Oklahoma. Individuals interested in such information may make a personal search of the 

records or may avail themselves of the services of a title search company or law firm. 

PLEASE REMOVE TIDS PORTION BEFORE SUBMITTING TO FAA. 

AC Form 8050-88 (03112) 
HEN REV JEllY DRONE SERIAL NUMBER AND MODEL 

Veterans Home Inspection Services 

Pittsford NY 14534 585-362-2848 

• II 
HJETTY 

From: 

Sent: 

To: 

Subject: 

Attachments: 

amazon ........_.,-, 

Hello henrey jetty, 

auto-confirm@amazon.com 

Wednesday, April 01, 2015 5:28 PM 

henrey jetty 

Your Amazon.com order of "BUNDLE Alpha DronePack with ... ". 

_Certification_.htm 

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Details 

Order #1 07-411 014 7-6379436 

Estimated delivery date: 

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Vtf!NI or manage order 

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28 LARCHWOOD DR ... 

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Unless otherwise noted, items sold by Amazon .com LLC are subject to sales tax in select states in accordance 

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Amazon.com LLC , it may be subject to state and local sales tax. depending upon the seller's business policies 

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Page 1 of 1 

D R ~ N E s ETC 

PACKING LIST: 341417 

Order No:107-4110147-6379436-DRN 

Shipping Manager 

4000 East Highway 6 

Dock#47 

Spanish Fork, UT 84660 US 

CUSTOMER PO CARRIER 

SHIP TO: 

Henrey D Jetty 

Attn :Henrev D Jettv 

28 LARCHWOOD DR 

PITTSFORD, NY 14534-2434 US 

TEL: 5856625896 

ORDER DATE 

107-4110147 -6379436-DRN UPS Ground Residential w/ Signat 4/2/2015 

ITEM LOT ID I EXPDate I DESCRIPTION 

BUSINESSCARD 

DJI-PHT-VISP-3 

DJI-VIS-BAT 

DP-ALPHA 

Packed by---------

BLACK BUSINESS CARD 

DJI Phantom 2 Vision Plus Version 3.0 (upgraded version) 

P2 P2V BATTERY 

FOAM AND LID INSIDE CANVAS PACK 

TOTALS 

SHIPMENT NO 

646906 

I QTY SHIPPED I UOM I 

4 

EA 

EA 

EA 

EA