Commonwealth of Massachusetts
MassDOT Aeronautics Division
AIRCRAFT DEALER REGISTRATION APPLICATION
Instructions
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N#
T21840-1010
Each Aircraft Dealer must register its Federal Dealer’s Aircraft Registration Certificate with the Massachusetts Aeronautics Division -----) and must pay the
applicable annual registration fee(s) to the Commonwealth of Massachusetts
Please print or type everything other than your signature when you complete this form.
Please fill out all of the applicable items on the reverse side of this registration form.
If you are renewing your registration, the information from last year’s registration is included on the reverse side of this Form.
Please check that information for accuracy and type or print any correction.
The annual registration Fee is $80.00 per Dealer plus $37per aircraft decal.
Please return all required information, including (a) the completed registration form, (b) a copy of your current Federal Dealer’s Aircraft
Registration Certificate, and (c) your check or money order for the registration fee(s) made payable to Commonwealth of Massachusetts :, Attn:
Aircraft Registration Coordinator, 611 Main Street, Worcester, MA 01608. Questions call: 508-753-2805.
Below, please identify all aircraft that are in your possession and are operated for the purpose of sale or demonstration.
Manufacturer
Model #
Year
Type
Color
Weight
Based
Airport
Owner
Address
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MassDOT Aeronautics Division
Aircraft Dealer Registration Application Form
Company:
Dealer Name:
Address(es) of Aircraft Owner(s):
Description
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Dealer’s Name
Dealer Doing Business As (“DBA”)
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Dealer’s Street Address, City, State, Zip
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DBA:
City, State, Zip Code:
Information
Dealer’s Phone Number
Dealer’s Fax Number
FAA’s Dealer Certificate Number
FAA’s Dealer Expiration Date
Massachusetts Use Tax Registration Number
Aircraft in Possession on this Date (see reverse side)
Number of Aircraft Decals Requested
Cost Per Decal (see Item 5 in instructions)
Total Cost of Aircraft Decals
Dealer Registration Fee (see Item 5 in instructions)
Total Fee Due (No. 15 + No. 16 = $X)
Check Number and Date
I/we certify that the information contained herein is true and accurate to the best of my/our knowledge.
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Signature
T21840-1010
Print
Name
Date
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