LICENSING: HELIPORT REGISTRATION FORM
PERSONAL INFORMATION
Full name: Charlie Baker
Contact number(s): 2731
Residential Address:
HELIPORT INFORMATION
Address(es): Police Administration Building, 2W Occupation Avenue, Alta
Number of requested pads: 3
---------------------------
Photograph(s) of the location(s):
ACKNOWLEDGEMENT & AUTHORIZATION
By submitting this request, I, Charlie Baker, hereby certify that the above statements are true and correct to the best of my knowledge. I fully authorize the investigation of any content shared on this document. I am aware that lying, omitting, or maliciously adulterating this request will result in immediate rejection and an indefinite ban from applying for a flight instructor certification.