January 23, 2004
Dear Sir or Madam:
This is a request for a United States identification number assignment for my amateur-built aircraft.
Make/builder - Scrivner
Type - Glider
Model - Quicksilver MX
Serial Number - 113
This aircraft has not previously been registered anywhere. ( reference section 47.15(a) (l) )
A reserve N-number - N 69QT has been requested, paid for, and confirmed. Please see attached copy of confirmation.
Attached is a Check, # 6662, in the amount of $5.00 as and for the registration fee.
Charles L. Scrivner ________________________________ Owner
4040 Knox Ave.