LICENSING: HELIPORT REGISTRATION FORM
PERSONAL INFORMATION
Full name: Gregory Butterworth
Contact number(s): 66661
Residential Address: 1205 Nikola Place
HELIPORT INFORMATION
Address(es): Butterworth & White Manufacturing
Number of requested pads: 1
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Photograph(s) of the location(s):
https://i.imgur.com/jCF5fVv.png
ACKNOWLEDGEMENT & AUTHORIZATION
By submitting this request, I, Gregory Butterworth, 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.