| Type of Event | Accident |
| Event Date | 11/21/2012 |
| Event Day of the Week | Wednesday |
| Time of Event | 1820 |
| Event Time Zone | Eastern Standard Time |
| Event City | Hillsdale |
| Event State | MICHIGAN |
| Event Country | -- |
| Zipcode of the event site | 49242 |
| Event Date Year | 2012 |
| Event Date Month | 11 |
| MidAir Collision Indicator | No |
| On Ground Collision occurred ? | No |
| Event Location Latitude | 415502N |
| Event Location Longitude | 0843333W |
| Event Location Airport | Hillsdale Minucipal Airport |
| Event Location Nearest Airport ID | JYM |
| Indicates whether the acc/inc occurred off or on an airport | Off Airport/Airstrip |
| Distance from airport in statute miles | 1.5 |
| Degrees magnetic from airport | -- |
| Airport Elevation | 1184 |
| Weather Briefing Completeness | -- |
| Investigator's weather source | Weather Observation Facility |
| Time of the weather observation | 1814 Eastern Standard Time |
| Direction of event from weather observation facility (degrees) | 90 |
| Weather Observation Facility ID | JYM |
| Elevation of weather observation facility | 1184 |
| Distance of event from weather observation facility (units?) | 2 |
| Time Zone of the weather observation | EST |
| Lighting Conditions | Night |
| Lowest Ceiling Height | -- |
| Lowest Non-Ceiling Height | -- |
| Sky/Lowest/Cloud Conditions | Clear |
| Sky Condition for Lowest Ceiling | None |
| Visibility Runway Visual Range (Feet) | -- |
| Visibility Runway Visual Value (Statute Miles) | -- |
| Visibility (Statute Miles) | 7 |
| Air Temperature at event time (in degrees celsius) | 9 |
| Dew Point at event time (in degress fahrenheit) | 6 |
| Wind Direction (degrees magnetic) | -- |
| Variable Wind Indicator | -- |
| Wind Speed (knots) | -- |
| Wind Velocity Indicator | Calm |
| Wind Gust Indicator | -- |
| Wind Gust (knots) | -- |
| Altimeter Setting at event time (in. Hg) | 30.17 |
| Density Altitude (feet) | -- |
| Intensity of Precipitation | -- |
| METAR weather report | SA 21/11/2012 23:14-> METAR KJYM 212314Z AUTO 0000 |
| Event Highest Injury | Fatal |
| On Ground, Fatal Injuries | -- |
| On Ground, Minor Injuries | -- |
| On Ground, Serious Injuries | -- |
| Injury Total Fatal | 1 |
| Injury Total Minor | -- |
| Injury Total None | -- |
| Injury Total Serious | -- |
| Injury Total All | 1 |
| Investigating Agency | NTSB |
| NTSB Docket Number (internal use) | -- |
| NTSB Notification Source | FAA |
| NTSB Notification Date | -- |
| NTSB Notification Time | -- |
| Fiche Number and/or location -used to find docket information | -- |
| Date of most recent change to record | Nov 26 2012 11:33AM |
| User who most recently changed record | lema |
| Basic weather conditions | Visual Meteorological Cond |
| FAA District Office | -- |
Aircraft Involved |
|
|---|---|
Aircraft #1 |
|
| Aircraft Registration Number | N40781 |
| NTSB Number | CEN13FA067 |
| Missing Aircraft Indicator | -- |
| Federal Aviation Reg. Part | Part 91: General Aviation |
| Type of Flight Plan filed | None |
| Flight plan Was Activated? | No |
| Damage | Substantial |
| Aircraft Fire | None |
| Aircraft Explosion | None |
| Aircraft Manufacturer's Full Name | PIPER |
| Aircraft Model | PA-28-180 |
| Aircraft Series Identifier | -- |
| Aircraft Serial Number | 28-7405065 |
| Certified Max Gross Weight | 2550 |
| Aircraft Category | Airplane |
| Aircraft Registration Class | -- |
| Aircraft is a homebuilt? | No |
| Flight Crew Seats | 2 |
| Cabin Crew Seats | -- |
| Passenger Seats | -- |
| Total number of seats on the aircraft | 4 |
| Number of Engines | 1 |
| Fixed gear or retractable gear | Fixed |
| Aircraft, Type of Last Inspection | Annual |
| Date of Last Inspection | Oct 5 2012 12:00AM |
| Airframe hours since last inspection | 8 |
| Airframe Hours | 2541 |
| ELT Installed | Yes |
| ELT Activated | No |
| ELT Aided Location of Event Site | No |
| ELT Type | -- |
| Aircraft Owner Name | Clarence J Avery |
| Aircraft Owner Street Address | 10615 Ocean Beach Road |
| Aircraft Owner City | Clark Lake |
| Aircraft Owner State | MI |
| Aircraft Owner Country | USA |
| Aircraft Owner Zipcode | 49234 |
| Operator is an individual? | No |
| Operator Name | Clarence J Avery |
| Operator Same as Owner? | Yes |
| Operator Is Doing Business As | -- |
| Operator Address Same as Owner? | Yes |
| Operator Street Address | 10615 Ocean Beach Road |
| Operator City | Clark Lake |
| Operator State | MI |
| Operator Country | USA |
| Operator Zip code | 49234 |
| Operator Code | -- |
| Owner has at least one certificate | None |
| Other Operator of large aircraft? | No |
| Certified for Part 133 or 137 Operation | -- |
| Operator Certificate Number | -- |
| Indicates whether an air carrier operation was scheduled or not | -- |
| Indicates Domestic or International Flight | -- |
| Operator carrying Pax/Cargo/Mail | -- |
| Type of Flying (Per_Bus / Primary) | Personal |
| Second Pilot on Board | No |
| Departure Point Same as Event | No |
| Departure Airport Code | I68 |
| Departure City | Lebanon |
| Departure State | OH |
| Departure Country | USA |
| Departure Time | 1700 |
| Departure Time Zone | EST |
| Destination Same as Local Flt | -- |
| Destination Airport Code | JYM |
| Destination City | Hillsdale |
| Destination State | MI |
| Destination Country | USA |
| Specific Phase of Flight | -- |
| Report sent to ICAO? | -- |
| Evacuation occurred | -- |
| Date of most recent change to record | Nov 26 2012 11:34AM |
| User who most recently changed record | lema |
| Since inspection or accident | Time of Accident |
| Event Location Runway Number and Location | N/A |
| Runway Length | -- |
| Runway Width | -- |
| Sight Seeing flight | No |
| Air Medical Flight | No |
| Medical Flight | -- |