12/22/2014 09:43 4252271007 

Jeffrey M. Harper 

FAA Office of Regional Counsel 

1601 Lind Avenue Southwest 

Renton, Washington 98057 

T (425) 227c216l 

F (425) 227c1007 

ANM7 

UNITED STATES OF AMERICA 

DEPARTMENT OF TRANSPORTATION 

OFFICE OF HEARINGS 

WASHINGTON, D.C. 

Jn the Matter of: 

Air Medical Resource Group, lnc. 

DMS No. FAA-2014-0551 

FAA Case No. 2014WP9l0076 

Honorable Richard C. Goodwin 

MOTION TO TAKE JUDICIAL NOTICE 

In accordance with l4 C.P.R.§ 13.218 and Federal Rule of Evidence 201, Complainant 

asks thatju.dicia\ notice be taken of: 

1. fAA Order 2150.3B, Chapter 7;"' 1 

2. FAA Order 2150.3B, Appendix B, Pages B-1 to B-3"' and B-31 to B-40;"' 2 

3. 40 C.P.R. § 40.ll(b),"' establishing that employers are responsible for the actions 

of their agents in carrying out the requirements of DOT agency drug and alcohol 

testing regulations. 

4. 74 F.R. 22653,"" recodifying .14 C.P.R. Part 121, Appendices I and J as 14 C.F.R. 

Part 120. 

5. 69 F.R. 1840,= in pardoular paragraph VA on page 1845, discu.ssing the FAA's 

deliberate intention of changing the pre·employ:rnent drug test requirement from a 

pre-performance requirement to a pre-hire requircroent. 

6. FAA Office of Chief Counsel Legal Interpretation, datedNovel)'lber 19,2014, 

addressed to Mr . .Edward Schaff,'~ reiterating that the 14 C.P.R.§ l20.109(a)(l) 

requirement requires testing prior to hire, 

7. FAA Office of Chief Counsel Legal Interpretation, dated May 31, 2005, addressed 

to Ms. Deborah McElroy, affirming that the pre-employment drug test 

1 A vail able at http://www.faa.gov/documcntLibrary/mec\ia!Ordor/2150.3B _ W -C.hg__ 6.pdf 2 !d. 

PAGE 02/12 
12/22/2014 09:43 4252271007 ANM7 

requirement is a pre-hire requirement, not a pre-perfonnance requirement. 

Enclosure \ .""' 

8. That U.S. Department of Justice, Financial Statement of Debtor (Business) is a 

six-page form, requiring attachments documenting and substantiating the debtor's 

responses, which must be signed by a representative of the debtor. Enclosure 2."" 

Respectfully submitted this22°cl day of December, 2014. 

Digitally signed by JEFFREY M 

HARPER 

.

d 4 &··· ·. DN: c,us, o=U.S. Government, 

/~·, //:1;. '~..----~-~ ou~ANM, ou~ANM, 

I,!- ----<:P"'-JHFREY M HARPER 

!'~M . . Harper Dote: 21)14, 12.19 16:18:1 B 

FAA Attorney _

08,00, 

Motion to Take JudlciBI Notice 

In the Matter of Air Medical Re$ource Group, lnc. 

OMS No. FAA-2014-055).; FAA Case No. 2014WP910076 

~8ge?.: of 3 

Jeffrey M- Harper. FAA Attorney 

T (425) 227-2J.61 

F (425) 227·1007 

PAGE 03/12 
12/22/2014 09:43 4252271007 ANM7 

CERTIFICATE OF SERVICE 

I hereby certify that the foregoing Motion to take Judicial Notice has been served via 

facsimile and Certified Mail- Return Receipt Requested this date, to the following: 

Attn: Hearing Docket Clerk, AGC-430 

Wilbur Wright Building- Suite 2W1 000 

F edcral Aviation Administration 

800 Independence Avenue SW 

Washington, DC 20591 

Fax: (202) 267-1293 

I hereby certify that the foregoing Motion to take Judicial Notice has been served via 

facsimile, Certified Mail- Return Receipt Requested, and e-mail this date, to the foUowing: 

Tb.e Honorable Richard C. Goodwin 

Office of Hearings, M-20 

1200 New Jersey Avenue, S.E. (EJ 1-310) 

Washington, DC 20590 

Fax: (202) 366-7536 

richard.goodwin@dot.gov 

Jared M. Allen, Esq. 

The Aviation Law Firm 

1997 Annapolis Exchange Parkway, Suite 300 

Annapolis, .MD 21401 

Tel: (301) 294-8550 

Fax: (866) 568-9886 

jaUen@aviation lawexperts. com 

Dated this 22"d day of December, 2014. 

{ta£ 'c'lZ~Z\tCz\ .... lf5ana Stephenson · ··' 

Offi.ce of Regional Counsel (ANM-7) 

Federal Aviation Administration 

1601 Lind Ave. SW 

Renton, WA 98057 

(425) 227-2164 

PAGE 04/12 

Mollon to Take Judicial Notice 

In the Maner oi· Alr Medical Resource Group, Inc.. 

DMS No. FAA-20H-0551; FAA Case No. 2014WP9l0076 

Page 3 of 3 

Jeffrey M. Harper, FAA Attorney 

T (425) 227·216:1. 

F (425) 227-1007 
12/22/2014 09:43 4252271007 

U.S. Department 

of Tmnsportatklh 

Federal Aviation: 

A<lrnlnl~!n>tl<on 

MAY 3 1 2005 

Deborah McElroy 

P:rcsidcnl 

Regional Airline Association 

Suite 800 

2025 M Street, NW 

Washington, DC 20036 

Dear Ms, McElroy: 

ANH7 PAGE 05/12 •-•\""1'··:,·-~·''''·'·,·:· · · 

BOO ln(J~p<ll160n"' AV2., S.W, 

Washinl)lon, O.C, Z0591 

As you k."loW, on, January I z .. 2004, w~ hE,d issued a fmal rule changing the 

pre-employm.ent testi,ng requiiemeiJt to 1t "prior to hire'' requirement lnl4 CFR part, 121, appendix I; 

section V.A Prior to the February !I, 2004, effective date of the regulatrJry cbange, you had asked 

for guidance to assist i!'l implementing the prior to hire requirement. On. Feb:ruary 3, 2004, Patrice 

M. Kelly, of my staff, sent you an email discussing the changes to the pre-employment testing 

requirements. 

The:.:e has been confusion among some employers regarding the guidance in the 

February 3, 2004 email, and thdr actions have rc8tilted in noncompliance with the pte-employment 

testing requirement. As you know, lt has been more than a year sine~ thl" regulation. !4 CFR part121, appendix r, cbanged the pre-employment testing requirement to a "prior to hire" requirement. 

We believe that the wording of the regula.tion is vcry clear and employers must follow the language 

of the regulation, Therefore, this letter rescinds the email sent to you un F ebmary :1, 2004. 

As y<>u know, 14 CFR part 121, appendix I, section V.A. clearly stares pre-employment 

testing must bt: conducted and a neg<ltiVe drug test result received before an individual is hired for a 

safety-sensitive futiction or tJ:ansferred from a non-safety-sensithre function to a safety-sensitive 

function. As we stated in the preamble to the final rule changing the prc,employ;ment testing 

req_uir<:ment back to "prior to hire":. "Pre-employment tc.'lting is directly tied to aviation safuty, in 

that it is a gateway to snfety~en:Jitiv<: positions. Fall (Ire of a proe<employrnent test is a direct bamer 

to an individual's entry into safety-sensitive positions," 69 Fcd9;al Regl!ite~: 1840, 1845 (Jan. 12, 

2004) 

We consider pre-employment testing to be parti~ularly critical because it has been th~ source 

of the largest nUlilbor of positive drug test results in the aviation industry, Between the inception of 

d1'Ug testing in 1990 and calendar yeat 2003, the aviation industry has reported 21,583 positive pre" 

employment drug test result,>. The reports received to date fur 2004 show 84S mor~ positive preemployment drug test results. 

Enclosure 1 

'•'. ' 180 
12/22/2014 09:43 4252271007 ANM7 PAGE 05/12 ' ' .. ~ . . ' .. ; ' . . ···.·.· .... ·.··, 

2 

In the 2004 final rule, we explained we were restoring the pre-1994 regulatory language of 

tooting "prior to hire" because pre-employment testing violations had become OU!.' most frequent 

em?loyer violation after the 1994 regulatory change. By going back to the "'prior to hire" language, 

we were re-establishing a ~lear event fur the pre-employment tQsting. ThlL'l, we believe more than 

ev<:t "it is vital that the language requiring pre-employment testing be as clear as possible in order to 

ma,xirnize the efficiency of its llJle." . 69 Federal Regi~ter at I 845 

Since the February 1 t, 2004 effective date of the final rule, employers have been required to 

conduct p•e·empioyrnent testing before :m indlviduaJ is hired for a safety-sensitive fu:oction. !t is a:n 

employer's responSibility to determine when~ individual is hired for a safety-sensitiv~:~ function. 

'The employer is in the best position to know whether the ipdividu.al has been hired :fur a safetysensitive function (e.g., pilot, flight attendant, etc.), or has been lilled fur a non-safety-seusitive 

function (e.g., reservationists, ticket agent, ctc. ), We e;>;pect each employer to pnHmployrrttlllt test 

:md receive the negative test result prior to an employee being bi{cl fur safoty-scrusitlve functions, 

even if the individual hM not yet begtm trllin±ug. , · 

In some cases, employers have now created a new ''trainee" position to circumvent the rule 

by blmrlng tlle understandi:og of"hire," Some employers have deci.gned multiple vmati.ons of this 

newly qeatcd ''trainee" position, even though the "trainees" m'e being tQrined ex:clusjvely for safetysensitive oositivns (e.g., pilot, flight attendaut, mechanic). m most of the cases we have seen wher~ 

employers have created a "trainee" position, we have not seen a clear Blld documented distinction 

between an individqal's "trainee" Stl<tus and the individual'S status as a safetycsensitive employee. 

As a result, these employers ate in violation of the rule by not perfonniog a p~-employrnent te~t and 

receiving a negative drug test result prior to the iriitiation of training these individuals who have b~n 

hired for safety-sensitive positions. These air carriers mU.St chl!1lg<.; their practices in order to be in 

compliance with the regulations, ' 

We hope this clarifies tbe F M position regarding the regulatory requircmepls, 14 CFR part 

121, appendili:. I, Section V.A. If you have any further questions about pre-employment testing prior 

to hiring in individoal fur a safety-sensitive position, please contact Patr:k:e M. Kelly at 

(202) 267·8442. 

Sincerely, 

Assistant 

~~t:¥- Chief Counsel 

Regulations Divisian, AGc-200 

1 B 1 
12/22/2014 09:43 4252271007 ANM7 PAGE 07/12 

U.S. Departmen.t of Justice 

Financial Statement of Debtor 

(.~ubmittedfor Government Actiott on 

Claims l)ue the United States) 

NOTE: Use additional sheets where space on this form 

is insufficient or continue on baok of last page, 

FINANCIAL STATEMENT FOR BUSINESS 

Authority for the solicitatil"rtl oftbc requested infurmat:i.o;n i;;; one or mo:re Dr the following; 5 U.S.C. JOJ, 901 (see NClte, Ex~;cutivc Order 6J66, June 1.0, 1933); 

2& U.S,C, 501, et seq,; 31 U.S.C, 9~1, et s.aq,; M U.S.C 3J.01; 4 CFR J ()1, et seq.; 2S CFR 0,160, 0. 171 sndAJ?pcndix to Subpart Y. Fed,R,Civ.P_ 33(a), 28 

U.S.C. l6;il, .3201 et seq. 

'Tbe prino~pal p1ll'posc for gnlhering this iDforrnation is to cvsluat~; yo,tr ability to pay lhe Government's claim or judgment against you. Routine 

uses oftbc infbnn(l.tion are esUiblhhed in tbc fu11uwing US. Departrocnt of Justi.cc Case File Systems P'tblis"hed in Vot 42 oftbc Federal Rcgi~er; 

.lust:i.oc/CfV -001 at p~gc 5332: .TusticcffAX-001 nt page l 5347; .lusticc!1JSA~005 ::.~t rrages 53406~53407: .lllStice/USA-007 rrt p;:~gc:;: 53408-~341 0; 

Ju.<:tice/CRIM-016 at pa.gc: 12274, bisdosurc (lfthe infomation is vohmtary. Ift1Jc rcquestc:d. infnrm~tion is l'lOt furnished, tile U.S. Department of Justi~X ha'i 

the: right to such d.i!;'closure oftlm information by legal methods_ 

Section 1 

Business 

Infom1ation 

Section 2 

Business 

Personnel 

and 

Section 3 

AccOl .. mts/ 

Notes 

Receivable 

Bvsiness 

l. Business Name ______________ _ 

Street Address 

Cily State ___ Zip ___ _ 

Councy.-~~~-~-~-----------­

la. Business Telephone L.J ---------~ 

2a Type ofenticy: (check one) 

D Partnership 0 Corporation D Other ____ _ 

2b. Type ofBusiness'.,.--;--,.-----------

2c. Other names that the business uses _______ _ 

3. Contact Name'-:---::::--;---;---:--:--· 

3a, Contact's Busi,oess Telephone L__) ____ _ 

Extension -=--=-o=----

Best Time To Call a.m. ___ y.m. 

3b. Contllct's Home Telephone (___) ____ _ 

Be<t Time To Call a.m. ___ y.m. 

3c. Contact's Other Telephone (__J, _____ _ 

Telephone Type (i.e. cellular, pa@r), _____ _ 

3d. Contact's E-mail __________ _ 

4. PERSON RESPONSIBLE .FOR DEPOSffiNG PAYROLL TAXES 

4a. Full Name Title Social Security Number _________ _ 

Home Street Address Home Telephone (__J.,-.,.---~------

Cicy State ___ Zip___ Ownership Percentage & Shares or Interest'----

5. J'ARTNERS, OFFlCERS, MAJOR SHAREHOLDERS, ETC. 

5a. Full Name Title Social Securicy Number _________ _ 

Home Street Address Home Telephone Ll·.,----------

Cicy State ___ Zip___ Ownernhip Percentage & Shares or In.terest~---

Sb. Full Name·-~..,..-------Title Social Sccmity Number _________ _ 

Horne Street Address Home Telephone L._),_,.-c=----c------

City State ___ Zip___ Ownership Percentage & Shares or Interest. ___ _ 

Sc. Full Name Title Social Security Number _________ _ 

Horne Slre-et-:-A-:-:cdd7 re-,-,------ Home Telephone (___)_,_ ________ _ 

City State ___ Zip___ Owne!$hip Percentage & Sbares or Interest ___ _ 

Sd. Full Name--,...,..-;.,-------Titlc Social Security Number _________ _ 

Home Street Address Home Telephone L-J.,..-~--~------

City State ___ Zip___ Ownership Perc<11tage & Shares or Interest~· __ _ 

6. A.CCOUNTS!NOTES RECEJV ABLE. Ustall contr~ct_., ~eparately, including controcts awardod., bLit not yet stnrt~d, 

Dcscriotion Amount Due Date Due Age of Account 

6a. Name $ o 0-30 doys 

Street Address D 30-60 days 

City/State/Zip D 60-90 days 

D 90+days 

Enclosure 2 
12/22/2014 09:43 4252271007 PAGE 08/12 

.Business Name ElN !'age 2 

Section 3 6b. Name $ 0 0-30days 

continued Street Address 0 30-60 days 

City/State/Zip 0 60-90 days 

If additional 0 90+ days 

space is ner;!dcd 

use separate 6c. Name $ 0 0-30 days 

sheet. Street Address 0 30-60 days 

City/State/Zip 0 60-90 days 

0 90+ days 

6d. Name $ 0 0-30 days 

Street Address 0 30-60 days 

City/State/Zip 0 60-90 days 

0 90+ days 

6e. Name $ 0 0-30 days 

Street Addres; 0 30-60 days 

City/State/Zip 0 60-90 days 

0 90+ days 

6f. Name $ 

- 0 0-30 days 

Street Address 0 30-60 days 

City/State/Zip 0 60-90 days 

0 90+ days 

6g. Name $ r:J 0-30 days 

Street Address D 30-60 days 

City/State/Zip 0 60-90 days 

0 90+ days 

6h. Name $ 0 0-30 days 

Street Address 0 30-60 days 

City/State/Zip D 60-90 days 

0 90+ days 

6i. Name $ 0 0-30 days 

Street Address 0 30-60 days 

Ci\y/State!Zip 0 60-90 days 

0 90+ days 

6j. Name $ 0 0-30 days 

Street Address 0 30"60 days 

City/Sta±e/Zip 0 60"90 days 

0 90+ days 

6k. Name $ 0 0"30 days 

Street Address 0 30-60 days 

City/State/Zip 0 60-90 days 

0 90+ days 

6a+6k=61 $ 

Amou~t from 

any separate sheet +$ 

Total Accounts/ 

Notes Receivable $ 

suer ness 
12/22/2014 09:43 4252271007 ANM7 PAGE 09/12 

Business Name. __________________ _ ElN _____________ _ Page 3 

Section 4 

Other 

Financial 

Information 

Section 5 

Business 

Assets 

*Indicate 

the amoun.t 

you could 

sell the asset 

for today. 

7. OTHER F!NANClA.L INFORMATION: Respond to the following business questions. 

7a. Does this business have other business relationships (e.g. subsidiary or parent, corpomti.cn, partnersh'p etc)7 

0 No DYes, list ElN Additional ETN ________________ _ 

7b, Does anyone (e,g. officer. stockho.lder, partner or employees) have an outstanding loan from the business? 

0 No DYes, amount $ Date oflosn Current Balan.ee $ _____ _ 

7c. Arc there :my judgments or Hens against your business? 0 No 0 Yes, who is creditor? ______ _ 

Dale of Judgment/Lien Amount of Debt$ _______ _ 

7d. Is your business a party in. a lawsuit'? 

0 No DYes, amount of suit$, _______ _ Possible completion dote'-----------

Subject matter of suit ________ , ___ _ Court filed in ___________ _ 

7e. Has your business ever filed banlmlptcy? 

0 No D Yes, date filed _____ _ Date discharged _____ _ Case No •. ____ _ 

7f_ In the past 1 0 years, have you transferred a.oy assets from your business name for less than their actual value? 

D No DYes, what asset Value at time oftransfer. ______ _ 

When was it transferred To whom \Va,'llt transfer:red, ________ _ 

7g. Do you anticipate any increase In busin.ess i:ncomc (e.g. contracts bid on but not yet awarded) 

0 No 0 Yes, why the i:ncreasc. __________ --;;c;;----,,-,:-;--,.-:-:--------

How much will it increase When wi11 it increase'--------

7h_ Is your business a. beneficiary of a trust, an estate or a life .insurance policy? 

D No DYes, uame of trust, e>latc or policy Anticipated amount to be received --------""Wc;;-he_n_t:-:o'b_e_r_e-ce""i-v-ed.,------

8. PURCHASED AUfOMOBILES, TRUCKS AND OTHER LICENSED ASSETS, Include boats .• RV's, etc, 

Current Loan Name of Purchase Monthly 

Descriruion Vahle~ Ba.lance Lender Price Pymt 

Sa. YeM __________ __ 

Make c-------- Modol, _______ _ $ ____ _ $ __ _ $ __ _ 

8b. Year _____ _ 

Make. ______ _ 

Model. ____ _ $. __ _ $ __ _ $ __ _ 

8c. Make Year ______ _ 

Model ______ _ $ __ _ $. __ _ $ ____ _ $ __ _ 

9. LEASED AUTOMOBILES, TRliCKS AND OTHER L!CllNSED ASSETS. lnclude boats, RV's, etc. 

9a. 

9b. 

Lease Name of Lease Monthly 

Description BatarJce Lessor Date Payment 

Year ____________ __ 

Make 

Model.-------

Year ___________ _ 

Make. _____ _ 

Model ______ _ 

$c__ __ $ ___ _ 

$ ·--- $ ___ _ 

J& ATTACHMENTS REQUtR.ED: Plea<;e prm·lde your cuNent s1:3tcmcnt frorn lender with monthly pnyn1cnt amnunt anO 

current bal<.\1'"/Cf: ofthc 1oM fO'I" each \'el:lic:le purchfise<;l or lca~ed. 

Business 
12/22/2014 09:43 4252271007 ANM7 PAGE 10/12 

Business Name. __________________ _ EJN Pag< 4 

Se~tiQn 5 

conlinued 

Section 6 

Investment, 

Banking and 

Cash 

Informatiort 

6us.iness 

.10. REAL ESTAT:t.List all real estate owned by the business. (If you need additional space, usa a separate sheet) 

Street Address, City Date Purchase CutTent Loan Lender/ 

Slate. Zip. County Purchased Price Value* Ball!DCC Lien Holder 

lOa. 

$ $ $ 

lOb. 

$ $ $ 

~ A:rTACHJ\.tEN'J'S REQlTJREJ): Plc.asc provide your currcmt statement from lender with rnon1:hly p<JYTilent amount and 

current b:al<lnce for cacb piece o:frcal csttlte 0\:vned. 

Monthly 

Payment 

$ 

$ 

11. BUSINESS ASSETS. Ust all business assets an.d encumbrances below, include Uniform Commercial Code 

filings. (fyou need additional space~ use a separate sheet) Note: If attaching a depreciation schedule~ the 

attachment must include all of the information requested below. 

Current Loan Monthly 

Description Value* Balaoce Lender Payment 

lla. Machinery $ $ --~-

$ 

$ $ $ 

$ $ ____ $ 

$ $ $ --- Equipment $ ___ $ 

----- $ 

$ $ $ 

$ $ ____ $ 

M.erchandise $ $ ____ $ 

Other Assets· (List below) 

1\b. $ $ $ 

llc. $ $ $ ----

~ A"rTAC:H:MENi.S REQlTTRED: Please prcyvide your c~1rrcnt sta1:crr1ent :8-om lcndc:t with m{)nthly payme11t: amount and 

currcn1. b•lancc for assets listed which hav<l an encumbrance. 

12. INV.ESTMENTS. List all investment assets below. Include stocks, bonds, mutual funds, stock options, etc. 

Number of Current Used as collateral 

Name of Company Shares/Units Value Loan Amount on a. Joan? 

12a. $. __ _ $ __ _ DNo DYes 

12b. $ __ _ $ __ _ DNo DYes 

12c. Tollll InvesC:ments $ ____ _ 
12/22/2014 09:43 4252271007 ANM7 PAGE 11/12 

Business Name·------------------- EIN Page 5 

Section 6 CQnt'inu~d 

6usin~ss 

13. BANK ACCOUNTS. List checking and savings accounts, (Jfyou need additional space) use a separate sheet.) 

l3a. 

13b. 

13c. 

Type of 

Account 

Full name of Bank, Credit 

Union or Institution 

Name ________ ~ 

Address·~-------

City/State/Zip _____ _ 

Namt; ___________ __ 

Address.__,-c---------

City/Statc/Zip· _____ _ 

'J'otal Other Account Balances 

Bank Account No. 

~ ATTACHME~IS REQlllRED: Ple;J...~e lnclud~ your cuttet\{ bo.n'k statcmc:nt.'l (chcck-illg and savings) 

[or 1he pa<;t 3 months for t~U accQunt'l. 

Current Account 

Balance 

$ ____ _ 

$. ___ _ 

$ ____ __ 

H. OTHER ACCOUNTS. List all acC<lunts including brokerage accounts, money market, additional checking, 

and savings accounts, etc. not listed on line# 13. 

14a. 

14b, 

Type of 

Account 

Full name ofBank, Credit 

Up ion or Institution 

Name, ___________ ~ 

Address·~~-----­

City/State/Zip. ------

Name, ________ _ 

Address·~~-------

Chy/State/Zip, _____ _ 

.14c. Total Other Accounts 

Bank Account No. 

Current Account 

Balance 

$. ___ __ 

$, ___ _ 

$. ___ _ 

iB1f' ATl'ACH'MEN'fS REQUIRED: Pka.<lc include yOlif current bank !ltatc:mcnts fut the past 3 month~ for allllccounts. 

15, CASH ON HAND. Include any money that you have that is not in the bank. 

l5a. Total Cash on Hand 

!6. AVAILABLE CREDJT. List alllin.es of credit, including credit cards. 

16a. 

l6b. 

Full Name of 

Credi.t T nstitution 

Namo> _____________ _ 

Address. __________ __ 

City/State/Zip> _______ _ 

Nrume. ___________ _ 

Address, _________ _ 

City/State/Zip> ________ _ 

I6c. Tota.l .Minimum P~ymcnts 

Credit Limit Amount Owed 

$ 

Minimmn 

Payment 

$. ___ _ 

$. ___ _ 

$. 
12/22/2014 09:43 4252271007 ANI.-17 PAGE 12/12 

}<am c. __________ ~~----------------~- SSN ______________ _ Page 6 

Section 7 

Monthly 

Income and 

Expenses 

17. The following information applies to income and expenses from your most recently filed Form 1120 or Form 

1065. Fiscal Year Period to ______ __ 

18. Accounting Method used: DCash D Accrual 

Tbc infonnation included on lines 1_9 through 39 should reconcile to your business federal ta.x return. 

Total Income 

Source 

19. Gross Receipts 

20. Gross Rental Income 

21. Interest 

22. Dividends 

Other Inc:omc (lines 23·2.5) 

23. 

24. _____ _ 

Gross monthly $ ___ _ 

25. =-...,.-c--=-c= 26. Total Income (19-25) $ ___ __ 

Total Living Emeg~e;< 

Expense Item!' 

27. Materials Purchased 

28. Inventory Purchased 

29. Gross Wages & Salaries 

30. Rent 

3 J_ Supplies 

32. Utilities/Telephone 

33. Vehicle Gasoline/Oil 

34. Repairsl1v!aintenance 

35. Jn.sumncc 

36. Current Taxes 

Other Expenses (lines 37-38) 

37.---------

Actn•l Monthly $ ____ _ 

38. ::;;-:----;c;;---:;;;;;-= 

39. Total Expenses (27-38) $----~--

~A TTACH:M'F.NTS REQUlREll: Please inc)\l~k proof of all curr1.mt expenses ih<lt you ps.id for the last 3 month.c;., 

il'lchlding.utilitics, rertt, il.'lsurancc, pro-perty taXc!,>:, otc. 

CERTIFICArJON 

I declare that I have examined the information given in. this statement and, to the best of my knowledge and bdicf. it is true, correct, 

and complete, and I further declare that I have n.o assets, owned either directly or ind.irect.1y. or income of any nature other that as 

shown in this statement, including any attachment_ 

Signature SociaJ. Security No. Date 

Title 

WARNING 

False st•tements are punishable liP to five ye•rs imprisonment, a fine o.f $250,000, or both pul"Suant to 18 U.S.C. §1001.. 

Buslnes~ 
12/22/2014 09:43 4252271007 ANM7 

FACSIMILE MESSAGE 

FEDERAL A VTATION ADMINTSTRA TION 

OFFICE OF REGIONAL COUNSEL 

ANM-7 

1601 LIND AVENUE S.W. 

RENTON, WASIDNGTON 98057 

PAGE 01/12 

The infon:nation contained in this facsimile message is legalJy privileged. and confidential 

infon:nation and is intended only for the use ofthe individual named on this cover sheet. 

If the reader ofthis message is not the intended recipient, you are hereby notified that any 

use, dissemination, distribution, or copy ofthis facsimile is strictly prohibited. If you 

have received this facsimile in enor, please immediately notify us by telephone at 

425-227-2007. 

DATE: 

TO: 

FAX NO.: 

PHONE NO.: 

RE: 

Decembcr22, 2014 

Docket Clerk AGC-430 

202-267-1293 

Air Medical Resources 

Group, Inc. 

DMS No FAA- 2014-

0551 

Motion to take Judicial Notice. 

NO. PAGES: 

FROM: 

FAX NO.: 

PHONE NO.: 

EMAIL: 

12 including cover 

Jeffrey M. Harper 

425-227-1007 

425-227-2161 

JEFFREY.HARPER.@FAA.GOV