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### 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 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 currentlyvalid OMS control number. OMS 2120- 0042. Comments covering the accuracy ofthis 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 OFOWNERSHIP FORAMATEUR-BUILT AND OTHER NON-TYPE CERTIFICATED AIRCRAFT (does not inclnde light-sport) 

## U. S. Identification 

## N534AD



# ----------------------------------------------------- Name ofAmateur 

## 1Non TC'd builder 

## DJI Innovations



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

## Phantom 2 Vision Serial Number 

## PH636044997 Class (airplane, rotorcraft, glider, weight shift control, powered-parachute, etc.) 

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

## Electric Manufacturer, Model and Serial Number ofeachEngine Installed 

## DJ I model 2212



# --------------------------- Serial# N/A Number ofEngines Installed 

## 4

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

### Built for Land 

### or Sea Operation 

## Land and Sea Number ofSeats 

# _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.) 

# [2] 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 ofownership from the aircraft builder through any intervening owners is attached (chain of ownership). 

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

### Name ofOwner: Signature ofOwner: Title ofSigner (IfAppropriate): 

## President



# ----------------- Address: City: 

## Seabrook 

# TX

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

### Zip: 

## 77586 Telephone: 

## 281-326-1800 Notmy Public: State of: County of: Subscribed and sworn to before me this 

# I

# Z t/JA. day of My Commission Expires:

# JZ L{

- ;:;)(_)

# 'Jd \}

- \!he

- (Signature ofNotmyPublic)

AC Form 8050-88 (03/12)

### 2/1/2015 HeiiPal.com



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### RC Boat (} RC Notorc.yclo 

### 0.. RCTanks (!. 

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### Accessoriesm

Q. Plane Spare Parts[!}

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ll8X004 ESC l'>.ower Cabfe USD $S.9fJ

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### English (dofalut) • Arable t Chlneso (Simplified) 1 ChJnose (l'r<tdll!omll) 

### • Dutch 1french 

### orderInformation order #32925G (Shipped) OHicrTradllng The pan:C!:I for th!s ordQr has bean shipped, 9209BOBBlil] Qidtr

**D~t~:** Sttuto5ay22 f'£bnJi'tY, ZOH Orduiot<J: Uso$1,105.85 

### Oellvew Addrt1ss Products 

### Daniel Harry 2034 

### Oceanvlew Drive seabrook, Texas 77586 United 

### Slates Shipping l·1ethod f?xpress (WC!:Ight: 5.62 

### 1

### x 0)1 

### Phantom 2.

**~lslon** 

### GPS Drone (RIF) W/ Free Extra Battery -Node:2 (Wl lllt"/Ua) -!id«.(«lQy USD $1,199,00



### KG.Delivery l!me: 

### 3-4 

### Days) 

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**xnrormt~.tlon** Ullllng Address oanlel

## nmv 2034 Ocemwlew Drive seabrook1 Texas 17506 

### Unlt13tl States Payment l·Iathod



### . PayPal Ordert-Ilstory 02/22/2014 \'/atung for PayPal

, 0nfCrmaUon 

### sub-Jotal: usn $1,199.00 Express (Weight: 5.62 KG. Oef!very Tlmn: 3·4 0,-.ys}: USD $106,85 

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## uso 0 "" : $1,305.85

02/2:2/20!<1 Procilsslng PayPallPN Verified 

### rpqyment stati!S: Completed {Vllrlflt::d; USD $1,305.85), 

### Customer PllyPal

**Mdress~** 

### Diln!el H<my, ?.034 OcennvJaw 

### Dr., senhrook, 77586,. 

### IX, U11lled Statos1 

### US, confirmed} 02/23J20ltl racklno D2j;Nj2.0!4 Shipped Order statuS; tJpdated

**outornotlc~\fy.** lho pMkago lorthis orderhus alrl!ady been shippedvia om Express. 

### You 

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### llttp:J/mwt.dhl.com.llk/contenVllk/en/express/tracklng.shtml? hrand.,.DHLMWB"'92091.H>8854%00%0A According to our experlence1 owr 9S0 /o> ofour custllmors can receive lhelr package- 

### on time, However', less

### than 5% oflh6 package:;; 

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### days becqose ofwslon\s Inspection orpost<\! doliW• Ifyou Cilrlllotre<:elve the packaoe within 10business d<Jys, ploase !:lndlt lotus know. 'Thanks a lotfor choosing HeliPal.coml


# Helipal.com Corporation Flat 8-E, UG/F, Co-Tack lnd Bldg,'17 Kin Fat Street, Tuen Mun , Hong Kong
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### Avr,.t) USD $441.20

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# AddendumtoACForm 8050-88 (03/12J for DJI INNOVATIONS PHANTOM 2 VISION, SERIAL NUMBER PH636044997, FAA registration number N534AD February 18, 2015 At the behest ofthe FAA representative, the following additional information is added for consideration for the registration ofthe aircraft: FAA Letter dated Februaty 12, 2015 from Oanh Tran. Comment a. Name ofowner has been changed to reflect D&C Inspection Services Inc. Comment b. NJA 

## Comment c. N

# J A Comment d . An invoice with the full name and address ofthe place ofpurchase has been enclosed. All craft operated by D&C Inspection Inc. are ofnew construction and are not and have never been registered in a foreign country. The manufacturer and the government ofthe country ofmanufacture do not require registration ofthese type ofcraft and no statement from the official havingjurisdiction over the national aircraft ofChina stating "the aircrafthas never been registered or that the registration as ended or is invalid" is available from the government ofthe country ofmanufacture. The DJI INNOVATIONS PHANTOM 2 VISION craftwas received new as a kit that was assembled, pre-tested, and modified to meet the minimum safety requirements.

Daniel Harry President, D&C Inspection Services Inc.