Aeroplane

Make:	Quad City Ultralight Aircraft Corp.	Manufacturer:	Quad City Ultralight Aircraft Corp.
Model:	Challenger II	Address:	Box 370
Serial:	CH2___________________		Moline, IL 61266-0370

Manufacturer's Statement:

The assembled Advanced Ultra-light Aeroplane described herein conforms with the Type Definition as declared in the Declaration of Compliance for the aeroplane type and model and has been found to conform to the Design Standards for Advanced Ultra-light Aeroplanes (TP10141) and is fit for flight.

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Signature of Inspector for Manufacturer	Date
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Name of Inspector (Print)

Registered Owner

Name:	____________________	Address:	________________________________
			________________________________

Owner's Statement:

I certify that the airplane referred to herein has been assembled from a kit for which a Declaration of Compliance is in effect, that it has been assembled in accordance with the manufacturer's instructions, that it has not been modified without the manufacturer's written permission, and that all Mandatory Actions have been completed.

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Signature of Owner	Date
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Name of Owner (Print)