Fill and Sign the Repossession 497337014 Form

AGENCY DISPLAY OF ESTIMATED BURDEN The Federal Aviation Administration estimates that the average burden for this report is .5 hour per response. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to the Office of Management and Budget (OMB). You may also send comments to the Federal Aviation Administration, Civil Aviation Registry, P.O. Box 25504, Oklahoma City, OK 73125-0504, Attention: OMB number 2120-0042. FORM APPROVED OMB NO. 2120-0042 U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION Aircraft Registration Branch PO Box 25504 Oklahoma City, Oklahoma 73125-0504 CERTIFICATE OF REPOSSESSION OF ENCUMBERED AIRCRAFT The undersigned hereby certifies that they are the true and lawful holder of a note or other evidence of indebtedness secured by a on the following described aircraft: (Type of Financing Agreement) Aircraft Manufacturer and Model _________________________________________________ Aircraft serial number FAA registration number _________________ Said financing agreement on the above aircraft bears the date of and was executed by ___________________ to and assigned to ______________________________ and is in the principal amount of . This financing agreement was recorded under Section 503 of the Federal Aviation Act of 1958, on the day of , __________, and was entered in the Agency record of conveyances as document no. . On the day of , , the aforesaid breached the obligations and promises contained in the financing agreement and the promissory note secured thereby. The undersigned certifies that they have performed all obligations imposed upon them by the terms of the financing agreement and all local laws; that in accordance with the terms of said financing agreement, and pursuant to the pertinent laws of the State of , the undersigned repossessed the aircraft described above on the day of , __________________, and that by virtue of such act of repossession they divested the said debtor, and any and all persons claiming by, through or under them, of any and all claims they had or may have had, and now hold title to the aforesaid aircraft, free and clear of all rights and claims of any persons whatsoever, as fully as if they had foreclosed in a court of law or equity. _________________________ - 1 - NAME OF HOLDER OF ENCUMBRANCE NOTE: If the agreement involved was not recorded with the Aircraft Registration Branch, the original or certified true copy should accompany this certificate of repossession __________________________ SIGNATURE (IN INK) __________________________ Title ACKNOWLEDGMENT (Not required for purposes of FAA recording; however, may be required by local law for validity of the instrument.) AC Form 8050-4 (6-99) - 2 -