OBSERVrn5 QUESTIOUIMIRE SECTIO~J A 1. When did you see the objectt 1.2 Time of Dayt r.: ' A.l.f, or 1.3 Time Zone: (Circle One): (il~ Eastern \,~ Central d. Pacific c. ltountain (Circle One): a. Daylight Saving @ Standard (Circle OnE:) 1.4 Circle one or the folloldng to indicate how certain you are of your nnslrer to the above question 1.2: Ca~) Certain 15: Fairly certain c. Not ver,y sure d, Just a guess 2. \Jhere lrere you when you saw the object: Postal Address Additional Remarl<s: 3. \Jhere werG you located uhen you saw the object: (Circle One): a. Inside a buildinz In an airplane 3 .1 \o!ere you: (Circle One): a. In the business nection of a city? In the residential section of a city? In open countryzide? Flyin~ near nn airfield? Flyinz over a ci ty? Flyin~ over open country? Ho,., did you happen to notice the object? S. l\'hen did you report to so1ne official that you had s een the object? SECTIO)l B 6. '\lfuat 't-rere you doing at the time you sau the objact? G.l What hod you been doing for the 30 minutes before you smT the object? 'fry to list the activity or activities nnd the approximate amvunt of time spent on each. 1. l~ere you moving at any time tThile you satr the object? (Circle One): IF you ansuered YES, the n complete the follot.Jing ques tion 3 : . 7.1 \"Jhat direction uere you movinz? (Circle One): n. North b. ~!ortheast d. Southc"-.st Southtres t Northv1est 7.2 HoH fast were you moving? r , miles pe r hour. 7, 3 Did you stop at nny time \1hile you trere looldng at the obje ct? (Circle One): Yes or No ~Jhat direction 'tzere )ou looking tJhen you fir~t sm1 t he (Circle One): a. North i'To rthea::;t r. Southue::;t East g. \:Jest 8.1 \rJh~t direction \rere you loolcing \o7hen the object disappeared? (Circle One)r ~Jotthv7est 8.2 Circle one of the follo~dng to indicate how certain you are of you1 answer to the above question and preceding question (8 and a. Certain c. l~ot very sure Fairly certain d. Just a cuess 9. Were you "'earing eyo glasses uhen you sau the object? (Circle One): Yes or (Nv 10. Hou t.Jas the object seen? Through theodolit3 Through sunglasses (Circle One): a. Through 1-tindo\or glass Through uindshield Through binoculars Throuch telescope Through open space - 11. \fuat do you remember about the weather conditions at the time you sa'toT the CLOUDS (Circle One) ~mATHER (Circle One) Clear sk-y o. Fog, ltl.st, or light rain Scattered clouds c. Moderate or heavy rain Thick or heavy clouds d. Snou c. Don't remember e. Don't remember 11.2 \IJIND (Circle One) 11.4 TEiiPERATURE (Circle One) Ho \>Jind b. Slight breeze c. Strong lrind d. Don' t re1nember tC, \'Tarm (;. yt>F C/ltl ;2t3C/.:Jt e. Don't remember Estimate h0\'7 lone you :Jal-1 the object? ~l~I1rn-u~t~e-s--Seconds 12.1 Circlo one or the follotd.np, to indicate hoH certain you nre or you1 ' ans;Jer =tc, Question 12t ( ~.' Certain b. Fnirly sure c. Not very sure d. Just a guess 13. Did the object lookt (Circle One) or Transpa~ent Did the object at any time: (Circle One for each question) Don't knou Change direction? Chonge speed? DOn It lmoH Change size? Change color? Doi1 t kno Brealt up in to parts or Yes ( 1\Jo e::cplode? Give off smoke? Yos Don't know Change brightness? Flicker, throb, or (l~o Don't l~not-t Remain motionless? Did the object give orr a lieht? (Circle One): IF you answered YES lmat nas the color or the light ? Tell in a feH l-Prds the f'olloHinz things about the object? IF there uas RE THAN ONE: o jec Drmr a pictu.re of hot-r they nere arranged and put an arrolr to sho:-r t he ~, .' . : direction they lrere traveling. Did the object at l1ove behind somethine;'? (Circle One) IF you o.nst-rered YES, the n t~ll \-That it r1vved behind. 18.2 Move in f'ront of somethinc? (C~.rcle One ) Yes QTq Don't knotr IF you ans1rered YES then tell t-rha t it moved in front or. 10.) Blend with the b ackground? (Ci-rcle One) Yes (J0.: Don't l ~nou 19. \o1h:\.ch or the follol-rine objects is about the same actual siz e ns the object. you s~1-1? (Circle One): r. Automobile b. Baseball g. Small airpla ne Basketball h. Laree airplane d. Bicycle uheel 1. e. Office desk 19.1 Circle one or the follold.ng to i ndicate hOH c erta i n you ar e or you r ans 11e r to Question 19. (8.':-Certai n ?. Fairly certain c. Not v ery su r e d. Unc e r tain 2(). Try to tell the follOlr.l.ng thinzo about the object: HoH high above the e arth lms it? Circle one or the folloHing to i ndic ate hoH certain you are of yol.tr anst-~1" 'Eo the above questions: Fairly c ertain i'!ot ver y sure Jus t a ~"uess 21. Hot-r did the object disapp ear from vie"t;J? (Circle One): a. Suddenly @ Gradunlly SECTIO:! D In thP fol~o~1ing sketch, imagine your eye on the curve d line to show hot-~ hieh the (skyline) Hhen you first smr it. Plac e you laot s aH it. d. Don't rcr'tember at the point shol 'll Place an "A" object Ha s above t ho horjzon to shoH 1 her e i t uas u!1en In the i'olloHl ne sk~ t.ch place you first snlf it, and n "B" nt the position the object uos , ,hen at its position l!hen you last s a"' it. Dra"t-r a picture that l-rill shou the motion "A" at the b eginnin3 or its p at:.h and a that the object maoe. "B" at the end of i t:J Drm7 a picture that will sh:>H the zhape of the object. Lobel :-nd in your sketch any details of the object that you s aH and place beside the draPing to shovr the direction the object lta3 movin3. nn arro~tr ()I /li If.. SEC'l,IOiT E 26. \'Ins this the firat time that you have seen an object like this? (Circle One): cr~ or No 26.1 IF you an~:\lrered ]!Q then \-Then, \-rhere , and under 'That concli t i ons did In your opinion what do you think t he object t-ras and l-Ih at might ha.ve c aused Give the following i nfo r mation about yourself: 29 . lv~s anyone else 't-r.tth you a t t he t ime you s aH tha object? (Circle One): ~:3~ or 29.1 IF you anm1ered YES, did they see the object too? (Ci r cle One): ~:s or No 29.2 Please list th~ir names and nddre3ses: PJ. case add here any furthP-r comments \-7hich you believe additional sheets or tho same sizo pap er, if are important, necessary. AIR INTELLIGENCE INFORMATION REPORT \ ,\U3tlitl Area Reported On Dato of Report te of Information Lcav ! BfarlkT Evaluation Prepared by (Officer) Roforenco:l number, directive, provious report, etc., aa app icablo (Enter concise summary of ropl)rt. Give significance in final onr.;t-&ento.1ce Inclosures at lower left. Be!)ln toxt of report on AF Form I '2--Part II.} pa ragraph. l.HlCLASSlFlE:D