COMPONENT HISTORY FORMPART NAME

Blade Assy, M/R

MANUFACTURER

Bell

PART NUMBER SERIAL NUMBER

205-015-150-101 A-FS340

RETIREMENT LIFE

10,000 Mrs

OVERHAUL LIFE

N/A

NOTES

Ref. Form 2408-16

INSTALLATION REMOVALDATE N#OR

LOCATION

TSN TSO A/C HRS ON

INSTALLATI

ON

DATE

REMOVED

A/C HRS ON

REMOVAL

HRS THIS

INSTALLATIO

N

TSN TSO NOTES

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MODIFICATION MANDATORY SERVICE BULLETIN

DATE MOD.# SIGNATURE & LICENSE DATE S/B NUMBER SIGNATURE & LICENSE

OVERHAULS - REPAIRS -ADJUSTMENTS - REPLACEMENTS

DATE TSN SIGNATURE & LICENSE

fY3./ rr

"form 1200 Rotorcraft Inc.KQTR784F

Box 453 (Hwy 63 & 117)Black Rock, AR 72415

■;'f

i

Work Order_i22— N 9 ̂ ^1614

Date Received ^ Date Released

Customer Name /// ̂ ^ S— ^ ^Address ^7&///^oJi f' PoaA f /7IY—nS

S IolJcSPart name

Part No. ^ OS- n/-3--/S£>-/O/

Serial Number A-S^3VO 4 A-J^S.399 ^Special Instructions a/^ Ae/^n hs /7 J>CL ia /7 ce

Work Accqmpjished

hi/! /j ta ;>" >, /

AS"/-2 3

y9P?SS'/s^-s./0-z3-/

i

FORM 1200

306it. o

3003.0 37"

Rotorcraft Inc.KQTR784F

Box 453 (Hwy 63 & 117)Black Rock, AR 72415

Work Order _ /3 N9^7-2007

Date Received

Customer Name

'-/3

///in Of 3 /~ X/7CDate Released

Address o^/^^d-, ^ ̂ ^ ̂ /Part name. XePart No. 2as~e>/3~/3o-Jol

Serial Number

Special Instructions (J

Work Accomplished, jFJpi 4L ^/^/]-/4sr)A^9'99 7Ai/^ns^/0 aL MA FUd, . /^o'A/ynfn^A

4/7 f9' 04. -/w.^ f/Tm

2io-Z3-\72J:

tZc^/A'uy)4\ r//F3'/330-

1. Approving National AviationAuthority/Country:

FAA/UNITED STATES

2.

AUTHORIZED RELEASE CERTIFICATEFAA Form 8130-3. AIRWORTHINFXS APPROVAL TAG

3. Form Tracking Number:

07-94-1614

4. Organization Name and Address:

RotorCraft Inc.

Box 453 (Hwy 63 & 117)Black Rock, AR 72415

5. Work Order/Contract/Invoice

Number:

07-94-1614

6. Item: 7. Description: 8. Part Number: 9. Eligibility: * 10. Quantity: 11. Serial/Batch Number: 12. Status/Work:

1 Main Rotor Blade 205-015-150-101 Bell UH-1 series 1 A-FS 340 Inspected/Repaired

13. Remarks:

Work Order # 07-94-1614 prescribing the actuai work performed is attached.

The prescribed work was performed in accordance with FAA approved data.

14. Certifies the items identified above were manufactured in conformity to:

[m Approved design data and are in condition for safe operation.

CH Non-approved design data specified in Block 13.

19. ^ 14 CFR 43.9 Return to Service LJ Other regulation specified in Block 13

Certifies that unless otherwise specified in block 13, the work identified in Block 12and described in Block 13 was accomplished in accordance with Title 14, Code ofFederal Regulations, part 43 and in respect to that work, the items are approved forreturn to service.

15. Authorized Signature: 16. Approval/Authorization No.: 20. Authoriz^^ignature|^^^^^_^^^^^^^ 21. Approval/Certificate No.:

KQTR784F

17. Name (Typed or Printed): 18. Date: 22. Naine'^(Typed or Printed):Jail's F. Propst

23. Date (m/d/y):1-16-08

User/Installer ResoonsibilitiesIt is important to understand that the existence of this document alone does not automatically constitute authority to install the part/component/assembly.

Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified

Bl^kl'' ®s'®ntial that the user/installer ensures that his/her airworthiness accepts parts/components/assemblies from the airworthiness authority of the countiy specified inStatements in Blocks 14 and 19 do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation certification issued in accordance withthe .national regulations by the user/installer before the aircraft may be flown.

FAA Form 8130-3 (6-01) *Installer must cross-check eligibility with applicable technical data. NSN: 0052-00-012-9005

I. Approving Civil AviationAuthority/Country:

FAA/United States AUTHORIZED RELEASE CERTIFICATEFAA Form 8130-3, AIRWORTHINESS APPROVAL TAG

3. Form Tracking Number:

13-37-2007

4. Organization Name and Address:

Rotorcraft Inc. Box 453 Black Rock, AR 72415

5. Work Ordcr/Contract/Invoice

Number:

13-37-2007

6. Item: 7. Description: 8. Part Number: 9. Quantity: 10. Serial Number: 11. StatusAVork:

1 Main Rotor Blade 205-015-150-101 1 A-FS 340 Inspected/Repaired

12. Remarks:

A general description of the work performed is attached as form 1200; Under the part description listed in blocks 6,7,8,10 and 11 as applicable.

A complete description of work performed is on file at the above referenced organization under the work order and system tracking reference numberindicated in blocks 3 and 5.

NOTICE: An Airworthiness Directive may apply to the article(s) described hereon. The installer is responsible for ensuring complete compliance with any

applicable Airworthiness Directives..

Part Total Time (As supplied by owner) 3082.0 Hrs

13a. Certifies the items identified above were manufactured in conformity to:

II] Approved design data and are in a condition for safe operation.Q Non-approved design data specified in Block 12.

14a. iZI 14 CFR 43.9 Return to Service Q Other regulation specified in Block 12

Certifies that unless otherwise specified in Block 12, the work identified in Block 11and described in Block 12 was accomplished in accordance with Title 14, Code ofFederal Regulations, part 43 and in respect to that work, the items are approved forreturn to service.

13h. Authorized Signature: 13c. ApprovaFAuthorization No.: 14b. Authopz^ Signature: 14e. Approval/Certificate No.:

KQTR784F

13d. Name (Typed or Printed): 13e. Date (dd/mmm/yyyy): Ijt^Name (Typed or Printra):

James F. Propst

]4e. Date (dd/mmm/yyyy):

10-04-2014

User/Installer Responsibilities

It is important to understand that the existence of this document alone does not automatically constitute authority to install the aircraft engine/propeller/article.

Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified inBlock 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts aircraft engiue(s)/propeller(s)/article(s) from the airworthiness authority of the countryspecified in Block 1.

Statements in Blocks 13a and 14a do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation certification issued in accordance with thenational regulations by the user/installer before the aircraft may he flown.

FAA Form 8130-3 (02-14) NSN: 0052-00-012-9005

o\

SERVICEABLE

MAINTENANCE RELEASE

THE AIRCRAFT AND/OR COMPONENT

IDENTIFIED ON REVERSE SIDE WAS

REPAIRED AND INSPECTED IN ACCORDANCE

WITH CURRENT REGULATIONS OF THE

FEDERAL AVIATION ADMINISTRATION AND IS

APPROVED FOR RETURN TO SERVICE.

PERTINENT DETAILS OF THE REPAIRS ARE

ON FILE AT THIS REPAIR STATION UNDER

Work Order No. QT-Q^-I ft l U

Dated 12-3-07

Inspected By James F. Propst

Remarks Inspected/Repaired

spx per Work Order.

ROTORCRAFT INC.Box 453 (Hwy 63 & 117)

BLACK ROCK, AR 72415

KQTR784F

SERVICEABLE

OManufacturer Bell Helicopter

Part Name Main Rotor Blade

Part No 205-015-150-101 , Serial No. A-FS 340

Owner Billings Flying Service, Inc.

Total Time

Inspector

943.1 TSO 943.1

Date 1—16—08

Additional Remarks On Reverse Side

oSERVICEABLE

MAINTENANCE RELEASE

THE AIRCRAFT AND/OR COMPONENTIDENTIFIED ON REVERSE SIDE WAS

REPAIRED AND INSPECTED IN ACCORDANCE

WITH CURRENT REGULATIONS OF THE

FEDERAL AVIATION ADMINISTRATION AND ISAPPROVED FOR RETURN TO SERVICE.PERTINENT DETAILS OF THE REPAIRS AREON FILE AT THIS REPAIR STATION UNDER

Work Order No. 1 3-37-7.007

Dated S-8-13

Inspected By —Jsmes F.—Propst

Remarks I^ispected/Repaired

per 'fAjork order.

ROTORCRAFT INC.BOX 453 (HWY 63 & 117)BLACK ROCK, AR 72415

KQTR784F

SERVICEABLE

Manufacturer ^ell Fgligppter

oPart Name Wain •Rn-Hnr- -nl aHo

Part Mffg05-01 5-1 50-1 01 Serial No.. A-FS 340

Owner Billings Flying Service, Inc.

Total Time =— —ISO.

Inspectoc

.0^

Pete 4 ~ ̂ 0-1 4

Additional Remarks On Reverse Side