1. DATI TIMI GROUP 4. NUMII!R 0' OIJICTI 6. TYPE o OISI!RVATION 1 . PHOTOS 9. PHYSICAL EVIDI!NCI! I. LOCATION 10. CONCLUSION FTD Ufl u 0-329 (TOE) 39. Do' you \hlnlc you can estimate the speed of the oliect? (Circle 'one} Yea No C/. IF you answered YES, then what speed would you estimate? IJ cl. T' Do yau thlnlc you can estimate how far away from you the obiect was? (Circle OneJ IF yau answered YES, then how for away would you say It was? 41. Please give the following information about yourself: TELEPHONE NUMBER Middle Name Zone Stato Age :J t.. Pleas~ Indicate any special educational training that you have had. , ~ e. e. T echnlcal school ---4~:i._Jl.JR .E!i.J.LI.. ;:_ _ a. Grode school ---------- t er special training 1/tLO , /!~'-:-/ d. Post graduate ----------- ~J.Jl_LL IS" 42. Date you completed this questionnaire: U. L AIR PORCI TECHNICAL IMPORMATIOM SHI!T In order that your Information may be flied and codecl aa accurately as ponlble, please use the followlftl spoce to write out a short description of the event that you observecl. You may re peat lnforii'IGtlon that you have already given In the questionnaire, and add any further comments, atotements, or slcetches that you believe are lmportont. Try to present the deta lis of the observn tlan In the order In which they occurred. Additional pages of the same size paper may be attached If they are n .. clect. (Do Not Write in This Spoc:eJ U. S\ A I R F 0 R C ~ T E C H HI CAL IMP 0 R MAT I 0 M 5 H ! E T Thia queationnalre has been prepared 10 that you can give the U. S. Air Force as much information 01 po11ible concerning the unidentified aerial phenomenon that you hove observed. Pleaae try to answer a1 many question as you pouibly can. The information that you give will be uaed for research purpoaes, and will be regarded os confidential material. Your nome will not be uaed In connection with any statements, concluslona, or publications without your pmiuion. We request this personal information so that, if it is deemed necessary, we may contact you for further deta i Is. ;~ see the obiect? 2. Time of day: At"rtrox. I jL()o /1.S T Hour M i nuto s (Circle One): 3. Time zone: (Circle One): a. Eastern b. Central c. Mountain/ d. Pacific 4. Where were you when you saw the object? (Circle One): a. Daylight Saving 16/1/LE.S ()./c-sr t!JF WtA/,1/?M~ /IFB Nearest Postal Address City or Town Stoto or Country Additional remarks: 1, Y/11/ &-3/S I) /1!1G. 9-DO() ',Nf .S I- S. Estimate how long you saw the obiect. Hours Minutes Seconds 5.1 Circle one of the following to indicate how certain you are of your answer to Question 5. (ci.) Certain b. Fairly certain Not very 1 ure Just a guess 6. What was the condition of the sky? (Circle One): {-;) Bright daylight b. Dull daylight d. Just a trace of day I ight e. No trace of day I i ght c. Bright twilight f. Don't remember 7. IF you saw the object during DAYLIGHT, TWILIGHT, or DAWN, where was the SUN located as you looked at the obiect? (Circle One): a. In front of you In back of you c. To your right d. To your left (e:'J Overhead f. Don't remember 8. IF you saw the oblect at NIGHT, TWILIGHT, or DAWN, what did you notice concerning the STARS and MOON? 8.1 STARS (C lrcle One}: 8.2 MOON (Circle One): a Bright moonlight ... Dull moonlight Co Many c. No moonlight -pitch dark d. Don't remember 9. Was the object brighter than the bockground of the sky? (Circle One): c. Don't romember b. No 10. IF it was BRIGHTER THAN the sky background, was the brlghtneu like that of an automobile headlight?: (Circle One) a. A mile or more away (a distant car)? b. Several blocks away? c. A block away? d. Several yards away? 11. Did th e obiect: (Circlo One lor each question) a. Appear to stand still ot any time? Yea Don't Know b. Suddenly speed up and rush away at any time? Yes Don't Know c. Break up Into parts or explode? Yes <tfg) Don't Know d. Give off smoke? Yea Don't Know e. Change brightness? Don't Know f. Change sha pe? Yes Don't Know g. Flicker, throb, or pulsate? Don't Know 12. Did the object move behind something at anytime, particularly a cloud? (Circle One): Yes @ Don't Know. IF you answered YES, then tell what It moved behind: _ 13. Did the object move In front of something ot anytime, particularly a cloud? (Circle One): Yes @ Don't Know. IF you answered YES, than tell what Did the obiect appear: (Circle One): Transparent? c. Don't Know. Did you observe the object through any of the following? a. Eyeglasses Yes No e. Binoculars Yes b. Sun glasses Yes No f. Telescope ~ll(rt?!Jff(i) Windshield \Y~j) No g . TJ.eodolite Yes No d. Window glass Yes No h. .16. Tell In few wonl1 the following thln11 about the oltlect. 5oun4 Nt1Air Ia. Color 'S/4 V C'R 17. Draw a picture that will lhow the thape of the oltlect or oltlectt. Label and Include In your aketch any detail a of the oltlect that you lOW 1uch aa wlnea, protrualona, etc., ancleapeclally exhaust tralla or vapor trails. Place an arrow ltetlcle the awing to thow the cllrectlan the oblect waa moving. .,.,-A,Nrof\r The edgea of the obiect were: Other~ ~tJ~Kc (Circle One): Fuzzy or blurred a. it. Like a bright star o o"" E c r Sharply outlined Co()l.O!/T Don't remember 19. IF there was MORE THAN ONE object, then how many were there? ------------- Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling. J#c-!>lfJcC T WIJ> Et T/lctf~ SM!Jt.t.. & <...:>~ t? j ~ /// /JR p~-rc--~MttJt:-JUSI 20. Draw a' picture that will 1how the motion that the obiect or objects made. Place an A at the beginning of the path, a a at the end of the path, and 1how any change fn direction d\H'ing the course 21. IF POSSIBLE, try to gueu or estimate what the real size of the object was in its longest dimension. 22. How large did the obiect or objects appear as compared with one of the following objects helcJ in the hancl ond at about arm's length? (Circle One): a. Head of a pin g. Silver dollar h. Baseball i Grapefruit ! I Basketball J e. Quarter f. Half dollar 22.1 (Circle One of the following to indicate how certain you are of your answer to Question 22. a. Certain c. Not very sure @ Fairly certain d. Uncertain 23. How did the obiect or objects disappear from view? la In order that you can give as clear a picture os pouille of what you saw, we would like for you to Imagine that you could construct the ollect that you sow. Of what type material would you make It? How Iorge would It be, and what shope would It hove? Describe In your own words a !ommon allect or oi.Jects which when placed up In the sky would give the some appearance as the altject which you saw, .SihtlcR IN <?t:J If T#tFcc FEET ~t.:;;. l,lttrrrc-~ 25. Where were you locatecl when you aaw the object? (Circle OneJ: 26. Were you (Circle OneJ o. lnalcle a bullcllng lt. In a car c. Outcloora @In an alrpl o. In the busineaa aectlon of a city? lt. In the residential aectlon of a city? c. In open countryalcle? cl. Flying near an alrflelcl? e. Flying over <:!:)Flying over open country? 27. What we you cloing at the time you aaw the object, ancl how did you happen to notice It? 28. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: What direction were you moving? (Circle One) a. North c. East II. Northeaat d. Southeast ttow ~at were you moving? I ?S tv1ft/ miles per hour. Old you atop at any time while you were looking at the object? (Circle OneJ Yea ~J 29. What direction were you looking when you first sow the object? (Circle One) (9 Northeast d. Southeast 30. What direction were you looking when you lost saw the object? (Circle One) @Southeast f. Southwest @,Northwest h. Northwest h. Northwest If you ore fomillar with bearing terms (angular direction), try to estimate the number of degrees the obiect was from true North and also the number of degrees it was upward from the horizon (elevation). 31.1 When it first appeared: a. From true North - -~-degrees. b. From horizon ~ s-degrees. Odvc- c l - 31.2 When it disappeared: 32. In the tollowlng sketch, Imagine that yau are at the point shown. Plac:o an A" on the curved I ine to show how high the object was above the horizon (skyline) when you first saw it. Place a "B" on tho same curved line to ahow how high the objoct was above the horizon (skyline) when you lost saw it. 33. In the following larger sketch place an A" at tho position the object was when you first saw it, and o "B" at its position when you last saw it. Refer to smaller sketch as an example of how to complete the larger sketch 34. What were the weather conditions at the time you 1aw the obfect? 34.1 CLOUDS (Circle OneJ ~Clear 1ky c. Scattered clouds d. Thick or heavy cloud e. Don't remember 34.3 WEATHER (Circlo OneJ b. Fog, mist, or light rain c. Moderate or heavy rain Don't remember 34.2 WIND (Circle OneJ a. No wind Slight breeze c. Strong wind d. Don't remember 34.4 TEMPERATURE (Circle One) e. Don't remember 3.5. When did you report to some official that you had seen the object? Day Month Year /o w e: f<.. ".'6. Was anyone else with you at the time you saw the object? (Circle One) ~jj;) No 36.1 IF you answered YES, did they see the object too? (Circle One) No 36.2 Please list their names and addresses: /5(iKEJ(S"F!ct...O 37. Was this the first time that you had seen on object or objects like this? (Circle One} y;, No 37.1 IF you answered NO, then when, where, and under what circumstances did you see other ones? 38. In your opinion what do you think the object was and what might have caused it? J r (/~vi. P /I liv-e-Cc-t:AI l t fr)fi Pllk FoIL (I.J ctJ TileR F #II/) ul t: uJ E"tf: .. c C: A. o S E ~-t!Jkt}/fi. IT /lrrc;1r:. t/cA.~Y F/1-.>r. #A rt/avc;:..tf tJIJ'JcC T 1fT /fiJi~ r 1