OMB Control No. 2120-0042 

Exp. 11/30/2014 

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

information is used to determine that the applicant meets the necessary qualifications as omer 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 dfsplays 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. ATTN: 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 

Name of Amateur /Non TC'd builder OJ I Innovations ----------------------------------

Model Phantom 2 Vision 

Class (airplane, rotorcraft, glider, weight shift 

control, powered-parachute, etc.) 

Serial Number PH636149022 

Rotorcraft 

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

lvlanufacturer, Model and Serial Number of each Engine Installed _D_J_I _ln_n_o_v_a_t_io_n_s __________ _ 

_ M_o_d_e_I:_N_I_A_S_/_N_: _N_/_A ___________ 

Number of Engines Installed _4 ______ _ 

Built for Land or Sea Operation _L_a_n_d __________ Number of Seats _0 _________ _ 

MUST CHECK ONE 

O More than 50% of the above·described aircraft was built from miscellaneous parts and I am the ovmer. (This option is for aircraft 

eligible for amateur-built certification.) 

0 More than 50% of the above-described aircraft was built from a kit (prefabricated parts) and I am the ovmer. 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.) 

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

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

NameofOwner: D&C Inspection Services 

Signature of Owner: 

Title of Signer 

M,..t......p't;:'s=X:.W~.L~;:kJ=!.i'l&lhj- (If Appropriate): _P_r_e_si_d_e_n_t ____ _ 

Address: 

city: Seabrook 

Telephone: 281-326-1800 

Notary Public: 

State of: 

Subscribed and sworn to before me this 

My Commission Expires: 

(Signature ofNotmy Public) 

AC Form 8050-88 (03/12) 

State: TX 

------ Zip: 77586 

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