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| Owner of Aircraft: |
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I hereby certify that this aircraft will not be flown/or is exempt from registration during the year 20
because:
If applying for an aircraft exemption. Please check one of the reasons:
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| N: |
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| Make: |
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| Model: |
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| Serial #: |
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| Address: |
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| City, State, Zip: |
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| E-mail: |
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| Date: |
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If sold, please fill out the following information:
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| New Owner's Name: |
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| Address: |
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| City, State, Zip: |
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| E-mail: |
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I hereby certify that this is a true and accurate statement.
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Electronic submissions do not require a signature. When submitted electronically, you are confirming that all information is true, complete and accurate.
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