SIGNATORY Report Form by twu35667

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									                                                                                                                 DEPARTMENT OF AVIATION - ROOM 201
                                                                                                                 5800 FLEUR DRIVE
                                                                                                                 DES MOINES, IOWA 50321-2854
                                                                                                                 Telephone: [515] 256-5100
                                                                                                                 FAX: [515] 256-5025


                                             SIGNATORY Aircraft/Airline Operator Monthly Activity Report
                                                                                    July 1, 2009 - June 30, 2010
                                                                                                                                                                                   Month

        Airline Operator Name:                                                                                                    Code:                                             Year          2010


     AIRCRAFT TYPE                             MCGLW                              NO. LANDINGS                                  TOTAL WEIGHT                          RATE                     LANDING FEE
                                              (in pounds)                                                                         (in pounds)                    (per 1,000 lbs)

                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                                      X                                             =                                    0   x       $2.12            =    $             -

Scheduled Airline Charters:
                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                                      X                                             =                                    0   x       $2.12            =    $             -


                                                TOTAL:                                                   0                                               0                           **    $             -




                        Aircraft Weight                               *        Rate (Signatory)                     *      Rate (Non Signatory)
                    Under 6,000 lbs MCGLW                                         $12.72 /Landing                                $17.82 /Landing
                   6,000 lbs MCGLW and Over                                        $2.12 /1000 lbs.                               $2.97 /1000 lbs.

NOTE: Airport Use Agreement operators operating without signatory airline affiliation should use "Rate (Non Signatory)", Affiliated Airline
Company Agreement operators should use "Rate (Signatory)"


         * Rates effective for operations on and after July 1, 2009, for all aircraft/airline operators.
        ** Remit Check Payable to "City of Des Moines".

The City of Des Moines reserves the right to make changes to the landing fees charged to signatory and non signatory airlines using the Des Moines International Airport during the period
July 1, 2009 to June 30, 2010. Scheduled Airlines must report Company Charters separately. Use extra sheets as required.



REVENUE PASSENGERS:                                                       CHARTER PASSENGERS:                                                 NON REVENUE PASSENGERS:

Enplaned                                                                  Enplaned                                                            Enplaned

Deplaned                                                                  Deplaned                                                            Deplaned

Total                          0                                          Total                                 0                             Total                          0


FREIGHT/EXPRESS (lbs):                                                    MAIL (lbs):                                                         THIS REPORT IS DUE AND SHOULD BE RECEIVED BY THIS
                                                                                                                                              OFFICE NO LATER THAN THE 10th DAY OF THE MONTH
Enplaned                                                                  Enplaned                                                            FOLLOWING THE REPORTED MONTH UNLESS OTHERWISE
                                                                                                                                              AGREED TO, IN WRITING, BY BOTH THE CITY AND
Deplaned                                                                  Deplaned                                                            AIRCRAFT/AIRLINE OPERATOR.

Total                          0                                          Total                                 0                             NOTE: REPORTS RECEIVED AFTER THE 10th MAY BE
                                                                                                                                              SUBJECT TO A LATE FEE OF $10.00 PER DAY




SIGNATURE - AIRCRAFT/AIRLINE OPERATOR                                       DATE                                 SIGNATURE - DSM DEPARTMENT OF AVIATION                                    DATE


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