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Form 291-A - Statement of Operations and Summary Statistics for Section 41103

Form 291-A - Statement of Operations and Summary Statistics for Section 41103

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Carrier          _____________________

Year Ended December 31, __________

Operating Revenues and Expenses

Transport Revenue:  
Property 1 ________________________
Mail 2 ________________________
Transport Related Revenue 3 ________________________
Total Operating Revenue 4 ________________________
Total Operating Expense 5 ________________________
Operating Profit or (Loss) 6 ________________________
Net Income or (Loss) 7 ________________________

I, the undersigned, (Title)__________________________ of the above-named air carrier certify that the above report has been examined by me and to the best of my knowledge and belief is a true, correct and complete report for the period stated.

Date                                            _____________________

Signature:                                  _____________________

Name (Please Type or Print)  _____________________

BTS Form 291-A