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2. 
3. Humboldt County Department of Aviation

   3561 Boeing Avenue, McKinleyville, CA 95519

   707-839-5401

   aviation@co.humboldt.ca.us

5. Aircraft Storage License Application
9. LESSEE
11. NAME:*
13. COMPANY NAME (IF APPLICABLE)
15. ADDRESS:*
17. CITY/STATE/ZIP:*
19. TELEPHONE:
20. HOME:
21. OFFICE
22. MOBILE:
24. EMAIL ADDRESS:*
25. SOCIAL SECURITY NO.
27. BILLING ADDRESS:

    (IF DIFFERENT FROM ABOVE)

31. AIRPORT
33. AIRPORT:*
34. RENTAL TYPE:*
35. REQUESTED HANGAR # (IF KNOWN)
37. REQUESTED LEASE/LICENSE START DATE:
    REQUESTED LEASE/LICENSE START DATE:
39. AIRCRAFT
41. MAKE & MODEL:*
42. TYPE:*

    1. Single Engine
    2. Multi-Engine

    1. Jet Engine
    2. Other
44. NAME OF REGISTERED OWNER(S):*
46. ADDRESS OF REGISTERED OWNER(S)

    (IF DIFFERENT FROM ABOVE)

48. REGISTRATION NUMBER:*
50. INSURANCE COMPANY:*
52. EMERGENCY CONTACT
54. NAME:*
55. TELEPHONE:*
57. RELATIONSHIP:
58. ADDITIONAL TELEPHONE:*
60. TO HUMBOLDT COUNTY, DEPARTMENT OF AVIATION

    I (we) hereby apply to lease a hangar on the terms and conditions set forth, and I (we) warrant that all the representations and information set forth in this application are true and complete and authorize you to verify this information. Any false statements on this application can lead to rejection of the application or immediate termination of the license agreement. I (we) hereby authorize you or any other agency employed by you to verify the information contained in this application and to investigate any other statements or other data obtained from me or from any other person relating to my credit, financial responsibility or personal characteristics. 

    It is understood that the final approval of this application will be the execution of the Lease by you. I (we) further agree to pay the first month’s rent and any deposits required upon execution of the lease and will provide a copy of aircraft insurance.

62. Agreement to Terms and Conditions

    1. I (we) agree to the terms and conditions as set out in the Aircraft Storage License Application
63. Date:
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field