NDAC - APPLICATION FOR PRIVATE AERIAL APPLICATOR LICENSE (MANNED) - SFN 2360

Application for Private Aerial Applicator License (Manned)

SFN 2360
No person may engage in the activity or business of aerial application in the State of North Dakota without first obtaining an aerial applicator's license from the North Dakota Aeronautics Commission.
Date

MonthDayYear
Date
Name of Owner/Applicant*
Address*

Street Address

CityState

Zip Code
County*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Questions about your FAA Part 137 should be directed to the Flight Standards District Office (FSDO) at (701) 492-5800.
Part 137 Agriculture Aircraft Operator Certificate Number*
Operator must provide copy of certification with this form.

Cancelof
Name of ND Chief Pilot*

Which Annual Required Safety Training Did You Attended?*

In-Person NDAC Safety MeetingPAASS ProgramSafety Meeting Video (Online)
Date*

MonthDayYear
Date

Where did the In-Person NDAC safety meeting take place?

Where did the In-Person PAASS Program take place?

Aircraft To Be Included On License

	Make/Model	FAA N Number	Owner's Name	Address	State Registration Number
Aircraft 1
Aircraft 2

Airmen To Be Included on License

	Name	Address	Restricted Cert Number	FAA Number and Rating
Airmen 1
Airmen 2

Lands Leased and Owned to Include on License*

	Description	Section	Township	Range	Leased or Owned
Land Lease 1
Land Lease 2

Applicant Signature*

Clear
Date

MonthDayYear
Date
Year
Should be Empty: