OMB

## Control No. 2120-0042 Exp. 11/30/2014 Paperwork Reduction Act Statement: The information collected on this form is necessaryto ensure applicant eligibility. The information is used to determine that the applicant meets the necessary qualifications as owner ofan amateur built aircraft. We estimatethat 

### it

### will take approximately 30 minutes to complete the form. The information collection is required to obtain a benefit. The information collected becomes part ofthe 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 ofthis burden and suggestions for reducing the burden should be directed to the FAA at 800 IndependenceAvenue SW, Washington, DC 20591. ATTN: Information Collection Clearance Officer, AES-200. 

## AFFIDAVIT OF OWNERSHIP FORAMATEUR-BUILT AND OTHER NON-TYPE CERTIFICATEDAIRCRAFT (does not include light-sport) U.S.Identiftcation 

# N534FD 

# ------------------------------------------------------ NameofAmateur 

## 1Non TC'dbuilder 

# DJI Innovations 

# ------------------------------------------- Model 

# Phantom 2 Vision + SerialNumber 

# PH645180724 Class (airplane, rotorcraft, glider, weight shift 

# Rotorcraft- UAS control, powered-parachute, etc.) Type ofEngine Installed (reciprocating, turboprop, 2 or4 cycle, electric, etc.) 

# Electric Manufacturer,Model and SerialNumber ofeach Engine Installed 

# _D_J_I_M_o_d_e_l_2_2_1_2 _________ _ Serial 

# # N/A Number ofEngines Installed 

# 4

---------- 

## Built for Land orSea Operation 

# Land 

# &Sea NumberofSeats 

# 0



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

# 0 More than 50% ofthe 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% ofthe above-described aircraft was built from a kit (prefabricated parts} and I am the owner. The bill ofsale from the kit manufacturer is attached. (This option is for aircraft eligible for amateur-built certification.} 

# lZ] 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 otherthan amateur-built certification.) 

# 0 Evidence ofownership from the aircraft builderthrough any intervening owners is attached (chain ofownership). 

# D Unable to obtain complete chain ofownership. Statement as to ownership history and whereabouts ofaircraft is attached. 

## Name ofOwner: SignatureofOwner: Address: City: 

# Seabrook Telephone: 

# 281-326-1800 Notmy Public: State of:



# ·-~ Subscribed and sworn to before me this My

**Commissio~xpires:**



# =t~ (Signature ofNotmyPublic)
AC Form 8050-88 (03/12) State: Title ofSigner (IfAppropriate): 

# President

----------------- 

# xas Zip: 

# 77586 -t------

County of:



# Y~ 

# .:so<f..t!. day of 

# MM-4

**ru~ /Lf~**  

# Qon ·

# AddendumtoACForm 8050-88 (03/12J for DJI INNOVATIONS PHANTOM 2 VISION+, SERIAL NUMBER PH645180724, FAA registration number N534FD March 30, 2015 At the behest ofthe FAA representative, the following additional information is added for consideration for the registration ofthe aircraft: FAA Letter dated March 25, 2015 from Jennell Woods. Commentb. The Affidavit ofownership has been updated to reflect the correct N number. 

# /,

**L/c~rj-~~-~** D;niel Harry -· ) President, D&C Inspection Services Inc.

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