UNITCO STATC& Of AMCJIJCA lXP AmMCNT Or



## TI'\AN~P()f'ITAT **OH** - fEDERAL A\MTION AOMIHISTRATI ON·MII<l M ONAOHIY AfAON A U ltCAL COflP AII.CIIAt-r

**Al:ClSlH~ ION**  AP'PI.ICATION UNfl'CO STAT($ 

# N '2 

# 2 

# A REGISTIWlO N NUMBER 

## 4' W AIRCIW'T MANUFACTlJRER & MOOEL 

# MJ .....

-11Wo:<J<S uA\1.

**~R..X** 

# 1'2- AIRCIW1' &RAl No 

# 1-NP- X l'loo'L TYPC Of' 

### AtGISTRA110N f(:heck 

### OM tlolt) H.JtiM AI-'""'HUVtU 

### OMB 

### No. 2 120-0042 CERT: ISS U E DATE F

OR FAA USE ONLY



# ~-... 02.-p 

# 0 3. 

## Co<J>ototoon 

## 04.Co-Owner 0 5. Goo.-emment 

## 0 8. lolon-OI"en Coq)otoloon 

## 0 ll 

# .......o-n Coq)ototxln 

# eo-o- HAM£ ORAPPLJCAHT

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**Of~** 

### n

**~ Qr~W**  k't!l

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**~** lktlaiJ

TF1 f'PHOIHF NUMBFR:



## ~J2 • 

# 9,....,- 0"2.0/ AOOAt.SS

**~ mW~g**  **"""*"tor~** eoohoem on 11M) I" PO Box • UNO, fllh't'I:IC:el addree:t mus. aJt()beShowf\1 Number ilnCI $1TMt 

# t'3sr3 f:Jt(IA 

# r<_ 

# 1-loU....CM/ RumiRoutc· P.O Rnx· CITY CTATC ZIPOOOC 

# AuS1/JJ --1"6)(4$ 7i'1'29 

# . 0 CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS ATTENTION! Read the following statement before signing this application. This portion MUST be co mpleted. A fnl(le o r di!#lont::m l lnw.-.,.to : • rty (f. l t'!.!ltiClfl if'l lhlll ll(lpi! CI IIIoll !fiftY bo Q I OOI'ldl' l (lt

**JXII'll~n'IO )1**  by fiM l ii 'KtfO.

**ilflpriflonrnl~t** (U.S. Codo. lltlit 18. 

### Soc. 1001 )..



## CERTIFICATION I M'r CfRTlrY; (1) That I M above 31reroft i8 QO,to'tle<J by t hot vi'\Citf'Oiqnoct

**~enc.** whO It a eltl:en iii'ICiudlftQ corporations• 01 the Unrted Statft. (Fa' YOI • \9 lru!lt, 9W OORl(l Of tf\IStet --- 

### ), or: g:HCCK OOC e§;

**APPR~RW~;** 

### a. 

## 0 AteSider't' 31.en. YO!th .-.n rtgistrt,fion ,.orm I·IC.1 OI',.OJm 1 -601) No. b. 

## 0 A

**f!Qn·O~ ~**  cwgnnif'Cd and dong b.IIWlotl$ un<IOf lf'IO laws of (siMttl lll'ld s.1id

**;~ircr.'lft** • ba8.s Wid po\mUrlly

**UM~C~Itl** the U""*' Stlt•

**f~** or Mlgrlt hCkn ate a-.3ilable kw' ir1$0f!Cb0tl at (2t Thet tr•

**~** 1$ not nlgl+:lec:recl londirr the klws ot

**"'~"~** lot09"

**~ry; ~**  l3) lllat legal

**~** or

**~** e auact.s 

### « "'- bclon -.cl wilt! tt. r edlttat A<A.<Ibot'l

**Adm~netration.** NOTE:

**Hex~** for c;cHM'net1hip 11 tiC)C)IICMtS must $9'1 · Use teYetSe side d 

### nec::essary. 

### TYP€ OR PRINT NAME BELOW 

### AE I



# ~ ..J. 

## mu MlF

**~** 

# ....

**~** 

# '-;¥3 d •tt :r"'"

**0~·'-'"'-"** ,_:>z 

## ....,::--

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## oz 

# """""""' nlU Dt.1r 

## ,_oo crt=w 

### <<Z

**00** 

### :t:JCO

**SIC~** '111\S IW£ 

### oa..,

**:i~CO** NOTC

**P~** rece(l4 oJ the Cettlt.ca!e 

### ot

**~an** lttQ!JtrKIOf\,

**the~** tNy bG

**~eel** for a period not

**in~** of90 

### diys. 6.1dng

**~iefl** b'N 1he PINK QOPV01 tt'lls

**~ion** mlm be cwnod in tM a11Q111t. AC Fonn 805().1 (5112) (NSN OOS2 · 00--9007)OMS Control No. 2120-0042 

### Exp . 11 130120 1 4 Paperwofk RCMJuction Act Statement: T he information collected on this form 

### i& nece&$3ry to ensure a.pplicant elig i bi l ity. T he • information is used to determine that the applicant meet(. the n ece.s.&.ary quafrfi eati on$ as owner ot an amateur buit a i ttr'dft. We estimate that it wi11 take approximately 30 minutes t o comp let e the fom1. The i nformation coUcction 

### is req ui red t o obta i n a benefit. T he info f mation collected becomes pa rt of t he a i rcraft fegistrati on system. Please not e 

### that an age n cy 

### may 

### not conduct or sponsor, and 

### a person i s not requ i red to res.pond to, a collection of infol'fl"\8t ion unless i t d i splays a currentty valid OMS contro l number. OMB 2120 · 

### 0042. Comments 

### covering the accuracy of 

### this burden and suggesti ons for r educing the burden should be di rected t o 

### the F AA a t 800 fndependence Avenue SW, Washington, DC 20591. ATTN : Information Coflection Clearance Officer, AES - 200. 

## AFFIDAVIT OF. OWNERSHIP FOR AMATEUR - BUILT AND OTHER 

## NON-TYPE CERTIF1CATED AlRCRAFf 

## (d<Je$ 

## not i. nclude 

## l ight -sport ) 

## 1J. S . ldcnLif ication 

## N242AW 

# ------------------------------ ---- -- -- -- ---- N'"ne 

## of Amuteur 

## I Nou TC'd builder 

## Mul ti works UAV 

# -------------- ---------------------------- Modcl ERX12 Scn al Number 

## HVP-X12002 C loss (airp laM. 

## rotor crafl. . glider. weight 

## shif t conlfol, 

## powered-parachute, etc . ) 

## Rotorcraft Type 

## ot' Engine ln sta1Jed (rociprocatmg . turboprop . 2 or 4**cycl~** 

### clcctlic, etc .) 

## Electric Manufacturer, 

## Model and S.:.ial Number of each Fnginc Inst alled 

## T Motor, Model Number: 307140711 All motors are identical without Serial Numbers. Numbcr ofEngmcs ln stallcd 12 

## (Twelve) Built 

## for Land 

## or Sea Operation _ L
_ a _

n _

d __________ NLnnbcr of Scat:;


## _ O _.:..

(Z

_e

_r

_ o ..;)

_____ _ MUST CHECK ON f.. 

# 0 Mo re than 50% ofthe 

### above-described aircraft: was bul l from mi:sce laneoU $ parts and I am the OY.It"'er. (Thi s opti on 

### is fo r aircraft el igible 

### t or**~mateurwbuilt** certification .) 

# 0 Mo re than 50% ofth e

### above~escribed a i rcraft was built from a kit (prefabricated partto) and I am the owner. The bi ll of sal e from 

### the 

### k it manufacturer is attached. (This option 

### l& for 

### aircraft c i giblc for amateur-built 

### certi fi ca tion. ) 

# 0 I certify that the 

### abovMescribed aircraft i s a newly bu i lt non-type

### certi**~a te** **d** a i rcraft and i s no t currentty reg i stered in another 

### country. (This optiotl 

### i s fo r aircraft eligible for experimental certification 

### other tha n amateur·built. ) 

# 0 I certify that the abovMescribed aircraft it; a previously built {used ) non4ype certificated aitaaft and is not currently registered in another country . (Thi& option is tor aircraft el i gible for experimental eenitica tion other t han amateur..I:Juitt certification .) 

# 0 Evide nce of ownership from the aircraft builder 

### through any i ntervening owners: is 

### attached {chain of ownersh i p ) . 

# O Unabl e to obts i n co mplete cha in of ownersh i p. 

### Statement a$ to ownership history snd where3bovts o f 

### a i rcraft i s 

### attached . 

## Nam e 

## of Ov.11cr: 

## Eric 

# C. Austin dba HeliVideo Productions, 

# LLC Si gnatur e of 0\\11cr. 

### c 

# == e:=: A ddrcs.. -o; : 

## 13513 Briar Hollow city . 

## Austin Telephon e : 

## (512) 917-0201 Nota1y Public: 

## State of:

AC Fom 1 & 

## 50-88 (03/1 2) State · 

## Texas Ti tle of 

## Signer (I f 

## Appropnat c ) . 

## 7.ip 

## 78729

XUE YAN My 

### Commission 

## E.q>lrH

January 

### 17 . 2016 I,_(l)(AAI. A\IIATIOH Al»oo..:STfiATION.,..,- **~AONEY** loEAOHAU'tiCAL CENTER AIRCRAFT AE"GISTRAnoN APPl.ICAYION 

# H VP- Xr'l.oo l FORM APf'f'CNfD
**OMBNo.21~2** 

### CERT: ISSUE DATE FOR FAA USE O.:..:N:;LY:...._., / m>f 

### 01' AECISi1W10H

# Poe<"""- fB"i. Individual 

## D 2. Part.n.:.h•P 

## 0 3. Co!'por3110n 04 . Co-Ownor 

## 0 S. Govornmont 

## 0 8, Non..Citizen
**Coi'J)Oft~Uon** 

## 0 9. Non-Citizen CorPOmlion Co-Owne.- on **~kkwl~** of (>'oiW'lef9hjp.lf.,<l•'w10Ual, gi.,..

**aa~** nNno. hrst

**~.** and middle lf'lit i 31.)

Numbef' and

**oot:** Rural Aoute ; QIY 

# AU$1/,J 

# n CHECK HERE IF YOU ARE ONLY REPORTING A CHANGE OF ADDRESS AITENTION! Read 

### the following statement before signin g this application. Thi s portion MUST b<l 

### compl eted.
**A...._or~....., to..,Q..li8MIOftifl.._~,_,btSIJ"l'UUII$kr~**  

### f1¥ line andbw•..,.WIWJilil!itt fiJ.$ . Coo$. Tcttt11. S.C . 1001 ).



## CERTIFICATION 1 /WI:. CCRTIFY: ( It Thnt tl'Je above arc: ran: Ia owned by the **~MIQneel** applbrrt,. \OifiO • • eili.ron
**~ndl.ld•ng cor~**  O'lti:n:s)

of fht tJrllted Stalet . (fOT '«<li'1g 1n.I:SI.

**~ IOMol~**  Cti[O<ON£ **ASAPPt~** 

## •· 0 A resi:Senl -.,, w•th ahn **regi~~tr•lon(Form 1~15**  **1** or f.orm 1·651) No. b. 

## 0 A non-cililt."''i c:or('IOtlltlon OJli3Ail(l(l ond dOII'!J b uslne68 ur\001 thO

**l.l~'S** or ($13ht)
_ _ nn(l $<lid all't:r'(ltl II bo!lod nrd prlmWIIY USiid io lhQ Vnitt<l StO.tU!I.

**R1~otd3** 

### or

**!1~1** hourn llt9 <JYallatllt lOt ir'ISpectron ilt 

### i2t That CO,. 

# OIIJQ- ilf IIIQt **~** IMIOOf the 10-M of iJII'f belqn 

### '*"ry. lnd 

### 1St 

## n. 11911
**~of** **CIW'*'$hp~&** a=.chld 

## or tas belln Qd•-.rt ._ **r~ ~**  *41 - lliZlllilt<lft. NOTE: H axocutOd t or co-ownet8hiJ) all app.licanttl must sign. Use mwtrM $Kie if
**ecEM~StYy**

**.**

M)rt- ,..endi•lQ t00C'1:)1 of tna Cer'lllieale

### <" AirerM 1-\egi&UMiOI\ , 1hr lllrettiM may be
**oper~to<l** 1 01' a l)&fioc::J noc in oKCM8 or 90 <1;)'1$. duriu 19 whlcl\ l lf'l'lt lhe PINK copy of l hlaappiicttt ion mu:ll be catrled in til(! t •irc!r'lltOMS Contro l N o . 2120-0042 

### Exp. 11/30/2014 P aperwor k Reduction 

### Act S tatement : T he i nformati on col l ected on this form i s nece$$3.ry to ensure app l icant e l igibility. The i nformati on is us.ed to determ i ne 

### tttat the appliea
_ nt meet$ the necessary qualifications C!l:& owner of an amateur built aircraft . We estimat e that it wil l take approximatety 3 0 minutes to comp l ete the fotrn . The inf o rmation ooflecti o n 

### is requ i red !o obtain a benefit Th e informatkm colleded becomes part o f the a i rcraft reg i st r ati o n system . Please note that an agency may not 

### conduct or sponsor. and 

### a person 

## ts not requi r ed to respond t o , a co l ection of i nformation u n l ess 

### it d i spklys a currently val i d OMS con tro l number. OMB 2 1 2 0 - 0042. Comment& covering the accu r acy of 

### this. b u rden and s u gge&tion& for reducing th.e burden $-hoUld be directed to the FAA at 800 Independence Aven u e SW, Washington . , DC 20591. AITN : Information**CoiJedionC~ranee** ontcer, AE- S..200. 

## tl . S. l dcnlificotion 

# N 2 19AW 

# ----------------------------------------------------- Name of Amateur 1 

## Non TC'd builder 

# Multiworl<s UAV 

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

# ERX12 Scnal Numbcr 

# HV P-X12001 Class (airp lane , rotorcrafl. glider, weight shift control. powered-parachute, etc .) 

# Rotorcrafl Ty pe or 1:-".nginc lnstaJicd (n. x .. --lprocat ing ..**turb oprop** **~** 

## 2 or 

## 4 t..-ydc.,. clcctliC) CI C . ) 

# Electric Manufactw-a·, Model ;md Selia! Number of each r.nginc Installed 

# T Motor, Model Number: 307140711 All motors are identical without Serial Numbers . NumbcT of Engines Installed 1 2 

# ( T welve) Built 

## for Land 

## or Sea Opo:ra lion 

# Land Nwnbor 

# or SoaL' 

# 0 (Zero) 

# -------------- --**--~ --** **-- ---**  

## MUST CHECK ONE 

# 0 More tha n 50% of

### the above-descri bed aircraft was buik from mi$celaneoU$ parts and I am the owner. (This option i$ for aircraft el i g i b l e to r amateur - bu i tt certification. ) 

# 0 More than 50°4 

### ofthe above-described aircraft vtas built from a 

### kit (prefabricated parts) and I am the owner. The bill of &ale from the 

### ldt**manufactu er~**  attached . (This option i s for aircraft eligible for amate u r-built certification. ) 

# [2] I certi fy tOOt the above-described a ircraft i s a newty bu i lt non-type cert i ficated aircraft and i s not currently registered i n another country. (This option is for aircraft eligible for experimental octtffication other than amatcur-budl) 

# 0 I certi fy that the above-described aircraft is a previously built (used) non-type cert i ficated a i rcraft and is not currently reg i stered in another country . (This option 

### is for aircraft eligible fo r experimental certification other than amateur-buitt certification.) 

# 0 Evidence o f ownership from the a i rcraft bu i lde r through any i nterven i ng owners i s attached (chain ofownership}. 

# O Unilbl e to obtain complete cha i n of ownersh i p. Statemoot as to ownership history and whereabouts of a.ircr3ft i Gattached . 

### Name of 

## Owner · 

# Eric C. Austin dba He · o Productions, LLC Signature of 

## Ch\1tcr: Address : 

## c i ty : 

# Austin State. 

# Texas Telephone : 

# (512) 9 1 7- 0201 Nota•y**J~Jbl ic** **:** 

### Stale of : 

## Subocribed and swom to before me Ibis
AC Fonn 8050- 03/ 12) 

# Zip . 78729

XU£ YAH 

### My Commiulon bplm January 

## 17, 2016