LICENSING: HELIPORT REGISTRATION FORM
PERSONAL INFORMATION
Full name: Darius Jackson
Contact number(s): 1788
Residential Address: 203 Cougar Ave
HELIPORT INFORMATION
Address(es): Richards Majestic Offices
Number of requested pads: 1
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Photograph(s) of the location(s):
Layout plan:
ACKNOWLEDGEMENT & AUTHORIZATION
By submitting this request, I, Darius Jackson, 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.
(( We would be considered to be leasing or renting the helipad. ))