NTSB Party Form Hartzell Propeller
PDF, 1 page from the NTSB's investigation of the Columbia Aircraft Mfg LC41 550FG accident near Gurdon, Arkansas, January 5, 2017. Shown as the NTSB released it (fetched from the NTSB as you open it).
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About this document
It is item 22 in the NTSB's docket for case CEN17FA071, titled "NTSB Party Form Hartzell Propeller" by the NTSB, 1 page. The NTSB removes some personal details before releasing docket documents; this site shows them as released and does not alter them. The docket at the NTSB.