5 Ci v~ .Ll.cm s 0:1Ject did to be r.tovi ocserv~::. yello\o~ o~ red, over pl.'!riod of di spl:'l.y :::luch nov~;.;ent, elliptical orbit. 12, Estimate hOM loag JOU aav the object? 2- Hours Minutes 12.1 OJ.~:aJ.! png of the following to indicate how certain you are or 7our answer to Question 12t Fa1r]J sure 13. Did the ob~eot loolca (Cirolt One) 14, Did the object at aey timea 14.1 Change direction? 14.2 Change speed? 14.3 Chango size? 14.4 Chahle color? 14.5 Break up into parts or 14.6 Give ott smoke? 14.7 Change brightness? 14.8 Flicker, throb, ar 14.9 Remain motionless? 15. D14 the object give ott a light? o. Not ver:~ aure 4. Just a gueaa (Circle One tor each question) No pon 't know, Pont knou Don't.~gy, lr$2 Jlon't hnmt Don't !now <EQn,it' }moW) .. Ohlt .. lCnO\i ~ Ron' 1i gow (Circle One): ~ No llpn'~ lme\! 15.1 IF you answered YES \that vas the color or the light? z('tuw 1J't!,'7.'~ 16. Tell in a few varcls the following things about the object? 16,1 Sound /f/6 So,.rAIO 17. lF there was HatE 'l'IIAN mlE object, then how mtley \.Jere there? Drav a picture ot how the7 were arranged, and put an arrO\J to ahow the direction they vere traveling. 18. Did the object at aD7 time a 18.1 Move behird aomethina? (Circle One) Xu. @ Pcm'~ )mo\f. lr JOU auwered tm, then tell what it moved behil1. 18.2 Move in front of &CIIIethins? (Oirole One) Jes J!~) J2g; IF 7ou answered m then tell what 1 t moved in front or 10.3 Blel1 with the background? (Circle One) Ie!! @ pon't )<now 19. Which or the following objects ia about the same ectual size ns the object you sav? (Circle One) t :: eball c. Basketball ct. Bic70le wheel e. Office desk t. Automobile 8. Smll airplane h. Large airplane 1. Dirigible 19.1 Qir;lg or the follCNing to iDlicnte hov certain you are or your 4D8t-1er to Question 19. c. Not very sure ct. Uncertain 20. 'l'r;y to tell the folle1r1ing things about the objectr How high above the earth was it? , lf:rnttJ feet. Haw far vas it from ;you? feet or z.5 miles Bow fast vas it goin&? J..u.tt /Cfl'~ miles per hour. Q.!,tple pnt of the following to indicate hov certain you are or JOur answer to the above questions 1 a. Certain b. Fairly certain o. NsU; - :ry sure d. cjust a guess) 21. How did the object disappear fran view? (C irole One) 1 a. 1-vci~!_nl.y ...._ b. <-G~aduall;y; o. Other --~- d. Don't rereember In the tollawtna eketob lmalin :your qe at the point shown. Place an "A" 011 the line lo ahow bow high the object was above the hori~on vhen JOU fk!i aav it. Place a "B" to ahow where it was when when you lat la\1 it. In the following sketch ~ce an "A" at the position tbe object was when J'OU first aaw it, and a 8" at its position \olhen you last saw it 24. Drav a picture that vUl show the motion that the objeot made. P:boe an "A" at the beg1nn!ng ot its path and a "B" at the end of its pata 15. a ploture tha\ vUl abow the abape ot the object. wbel anc:l include in rour 1ketoh ClD1 details of the ob3eot tba t rou 1av and pl.a ce an arrow '-14 the c!rovial to eb"" the direot101l the object \IU Jllovinl 26. Wne this the first time th3.t you have seen en objeot like this? (Circle One),l ~ee I no 26.1 lF you anfNered 1-TO, then when, where, nnd under vhat conditions did J'OU see other ones? ------------------ 27. In 7wr opinion what do you think the object vas and \lhat might have caused it? 20. Give the following information about Jourself'a TEI.tPHOME NtJ.mm What is your present 3ob? .RI,l!~8"""1L'~ /fi/9/,;_/,:, :/ sex dO'-c, Last School Atterned 01.1. /fft.,t:) /?A~Y /11X> ;=t.d c c ~#J'c .; /i't. Year of last attendance at this school f9rf \faa DJOH else \lith 70U at the time you saw the object? (Cirole One) 1 lF 70ll aDI\Iered !itS, did the7 the object toot (C!role One) 1 (!~ or b namea and a4dreaaeat 1. Vhen 414 JCN aee the objeot a 1.1 Date a tt. 1.2 TiM of 4qa 2.0 (Jh or P,J.I, (Circle One) Bra. Min 1., '' Zone a (Cirole One) a ) Eastern b. Central .o. Mountain (Circle One) t f. 4. Pacific 1.4 QM ot the tollowinl to indicate how certain J'OU are 70ur answer to the above question 1.2 t a. Certain CD) Pair~ oertaiD 2. \there 414 JOU lee the objeot! o. Not ve%"f sure 4. Just a guess 3. Where were J'OU located when ;you saw the objecta (C !role One) t a. Inside a bu5ldins b. In a car 4. In an airplane Outdoors 3.1 Were ;yout (Circle One) 1 a, In tha business section ot a city? @) In the residential section ot a o. In open countryside? c!, Flying near an a~tield? e, Flying over a ci t7? t. Flying over open country'/ 4. How did you happen to notioe the objeot? lr \N~S ~all'hf To "lrt)! 5. When did JOU report to some otfioial that you bad seen the object? i ~lbat were you doing at the time you eav the object? OvTJAQ%1 6,1 ~lhat 'had you been doing for the 30 minutes before you saw the objeot? Try to list the activity or activities, and the approximate amount or time spent on each. _G,tl)'llp l"k 1h.13ll tJelbrr; beea..-c 9Cic1c-wl Tl'Mt (IO'h'l"') '1. Were you moving at aJl7 time 'WhUe J'OU saw the object? (Circle One): IF JOU answered YES, then complete the tolla1 ing questions. 7.1 \oJhat direction uere 7ou moving? (Circle One) 1 a. North b. Northeast d. Southeast t. S outb'West h. Northwest 7.2 How fast vere you moving? milos per hour. 7.3 Did you stop at any time \-Jhile you were looking at the object? (Circle One) 1 Ie~ or e. Vbat 41Notion were JOU. taclna \lhen JCN tirat aav the obJect? (Oirole Cbt) a a, IICI'tb q) Southw11t h. lfortbveat Ia, lartheaat 4. Soutbt 8,1 What direction vere JOQ tacina when the object 41Jappeared? (Circle ODe) 1 lortb South b, lo:rtheaat t. Southwest o. But C\ West 4. Southeast lr. Nortbwt ot the tol l.awq to ildicate hew oertain JOU are of anaver to the abcmt two queationa, (8 an4 8,1). Cl\ Certain b. Fairq certain c. Rot va17 sure 4. Just a guess 9. Vare JOU weQring e7e glaaaea when rou saw the object? (Circle One) t 10. RfN waa the object aeen? (circle One) 1 a. ThrCJUih window glaaa b. Through w1ndabiel4 m through b:lnoculara a:. !broush telescope e. Through theodolite t Through sun glasses \ Through open apace 11. tolhat 4o JOQ remember about the weather oor11tiona at the time you eav the object! 11.1 OLOOIS (Circle One) c. Soattere4 olO\ds 4. Thick or heav.r clouds Don't remember WIMD (Circle One) Slight breeze Strong wind 4. Don't remember 11,3 ~lEATHER (Circle One) b. Fog, l-Ust, or light rain o. 1-loderate or heavr rain e. Don't remember TEMPmATmE (Circle One) D~n't remember 12. latimate how loq JCN aaw the objeot7 ~-...l'r..-. Minutea Sec oms 12.1 of the fo11ow1na to 1n!1oate how certain you are or rour &n8\tl81' to Que otion 121 Certain (!) Fairl.T sure o. Hot Te%7 aure c!. Juat a aueaa 13. Did the object 1oolu (Circle One) 14. Did the object at 117 time: 14.1 Chpnge direction? 14.2 Change a peed? 14.3 Change size? 14.4 Change color? 14.5 Break up into parts or 14.6 Give off smoke? 14.7 Change brightness! 14.8 Plioker, throb, ar (Circle One for each question) P pn,'. t kqow l! on'~ knO\! llon' t know :Q on' jj Jmw pulsate? 12 {!on.'~ knOH 11 .. 9 Remain motionless! 112 pont kDO\! 15. Did the obJect give ott a light? (Circle One): <iii J!2 Pon't knCM 15.1 D' J'OU anavered m, what vas the color or the light? R~J :4 a bTC!4t"\ 16. !ell in a fev warda the following things about the object? 16.2 Color cLanJeJ c.oLox froM RsJ To. ~'l'6lf:!l f_o-,r.~-,Tf.r 17. IF there was 1-tCBE THAN OtlE object, then how maD7 'Were there? Draw a picture ot how thq were arranged, and put an arrow to ahow the direction they were traveling. AF FORM 112-PART I APPA.)Vf.D I JtmE ltU AIR INTELLIGENCE INFORMATION REPORT SUMMARY: (Eitlno elllt, ,.,. ., tfrt,.,. OtN ,..}kella Ia ftMl ottNIIIIrlltf ,_.,opt.. LW ,,.tl.,., oli,IDtf ltfl. Dtthlln1 of rtporf em .tl ~ J'wttt I tt-l'orl II.)