1. a) Name of Airline

Not Applicable

    b) Three-letter ICAO designation

Not Applicable

    c) State of Registry

United States of America

2. Aircraft identification (flight number) not more than 7 symbols

3. a) Aircraft type of ICAO classification:

        (basic and alternative)

    b) Aircraft Registration mark

c)      Take-off/landing mass of aircraft:

(basic and alternative)

4.  a) Owner of the aircraft:

     b) Address of owner:

5. Purpose of Flight

    (the interested organizations/persons in

      Russia)

Pleasure

Anadyr Government Administration

Provideniya Bay Airport

6. Category of Flight:

     (Charter, additional, business and other)

Private

Recreation, Tourist

7. Flight Crew (with indication of

                          nationality)

8. a) Passenger (the number, nationality)

    b) Cargo (its characteristics)

    c) Charterer and his address

9. The date of flight operation and schedule (UTC) with indication of the points of commercial and technical landings (in ICAO codes), the points and estimated time of entry/exit into/out of the airspace of the Russian Federation (CIS):

10. The form of payment of services and state charges:

     (for clearing settlement – indicate the

       address of the payer, the bank, account

        number)

11. Remarks