1. DA T! TIMI GIIOU' S. LINGTH Ofl OlllltVATION 6. T'tltl 0, OaiiiYATION t. ltHYIICAL IYIDINCI I. LOCATION "Jrool~ n , U. atttlfl IUMMAIIY ... ANALYIII U. I. A II P 0 R C I TIC H MICA L I H P 0 I MAT I 0 M I HI IT In arller that your lnfarNtlon NY '-flletl and cedetl occuretely as po11lble, pleaee use the follewl"' ''c to write eut a ahott cleecrl,.len of the went that you obtervecl. You mor , .. ,.., lnfor"'otlon tt.t you ha~ crlreadr given In the queetl~lre, oncl add ony furth comnnta, atate"'nta, slcetchtts tltnt retu h~ll.,.., ore l,..artant. Try to present the detaUs of the olservo- In the ordr In wltich thtty N:r wred. Additional pope af the some slae paper may be attcrched If th., are nettded. (Do Not Write Itt Tltla Space} , j f/Jit.) IMPORMATIOH SHIIT Thl1 ttu.ltlonnalro ha1 been preporocl 10 thot you can give the U. S. Air Force a1 mvch Information po11lblo concerning the unidentified aerial phenomenon that yov have obaervocl. Plea try to on1wor aa many qve1tion1 a1 you poulbly can. The information that yav give will k vaed f rHearch pvrpoao1, and will be regcardell a1 confidential material. Yout nome will nor in connection with any statemont1, conclu.ions, or publicotiont without your pmiuion. We request thlt peflonal Information 10 that, If It It ciNmed neceuary, we may contact you for further dotaila. 1. When dicl you aoe the obiect? 2. Time of day: (Circle One}: 3. TIme zone: a. Easter;) c. Mountain (Circle One}: d. Poclfic City or Town Stote or Country 5. Ettimate how lang you saw the obiect. 5.1 Circle one of tho following to indicate how certain you ore of your onawer to Question 5. a. Certain c. Not very aure d. Just a gveu (b. Fairly certai~ (Circle One}: a. Bright daylight b, Dull daylight c. Bright twilight d. Just a trace of day I ight C! N; trO:~ of darHgljD f. Don't remember 7. IF yov aaw the object during DAYLIGHT, TWILIGHT, ur DAWN, where wos the SUN locgted as you looked at the obiect? (Circle One}: a. In front of you d. To your left b. In back of you e. Overhead c. To your right f. Don't remember 8. IF you aaw the oialed at NIGHT, TWILIGHT, ar DAWN, what cUd you natlce concnlng the STARS and MOON? L1 STARS (Circle One): 8.2 MOON (Circle One): ~ Bright htJ b. Dull moonlight c. No moon I ight -pitch dart. d. Don't remember 9. Waa the olttect brighter than the baclcgrouncl of the alcy'P (Circle One): a. Yea b. No 10. IF It woa BRIGHTER THAN the ally bocllgrouncl, woa the brightness lilce that of an automobile headlight?: (Circle One) o. A mile or more away (a dlatont cor)? b. Several bloclca away? c. A blocll away? d. Several yarda away? e. Other . feb (/) IJ (qP nc d 11. Dlcl the obiect: (Circle One lor eaclt question) a. Appear to stand atlll at any time? b. Suddenly speed up and rush away at any time? c, Brealc up Into parts or explode? cl. G I we oH 1 molce 'I e. Change btightnea 1? f. Change shape? I Fliclcer, throlt, or pulsate? Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know 12. Olcl the oblect'rnove behind somethl at anytime, particularly a cloud? ( C lrcle One): Yea No Don't Know. IF you answered YES, then tell what 13. Did the object move in front of something at anytime, particularly a cloud? (Circle OneJ: Yes Don't Knnw. IF you answered YES, than tell what a. Solid?' Old the obiect appear: (Circle OneJ: Did you observe the obiect through any of the following? a. Eyeglasses Sun glasses Windshield Yes g. J. Window glau Yes h. ti, IJ/v r~ Transparent~ c. Don't Know. Blnoculan Yea Telescope Yea Theodolite 16. Tell 1ft a few w the following thlnga altout the olllect. ~ Color ~'/l17e - 17. Draw a picture that will lhow the thape of the olllect or olllecta. Label cmcl Include In your aketch any detail a ef the olttect thot yov HW euch a1 wlnge, pt'otrutlont, etc., ancletpeclally eJChoutt tralla M vopor troils. Ploce an amw leslcle the awing to ehow the direction the olttect woe m01ng. 18. The edges of the obiect were: (Circle One):&: rr-t:~ ~r==-;') c. Sharply outlined d. Don't remember 19. IF there waa MORE THAN ONE obiect, then how mony were there? -M~s...n:.. _ Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling Draw picture that wlll ahow th MOtion tltat th. '-feet or oltlect mod. Place on A at tho iteglnnlng of the poth, a ot the end of the P.th, and aftow oftJ chongea In dlrectlan during the cauree. IF POSSIBLE, try to gue11 ot e1tlmate what thw real elze of the ol,fect wa1 In ltl longest dlmenelon. 22. I low Iorge dicl the oltfect ot oltiect oncl ot oltout ar"'' 1 length? ae compa~ecl with one of the following object ltelfl In tlte ltortfl (Circle One): a. I locl of a pin Sliver dollar Grapefruit d. Nlclcel Boslcetboll lc Other f. Half dollot . 22.1 (Cirde One of the following to indicate how certoln you are of yow answer to Quetion 22. \~C~rtoln/ c. Not very aure Fairly certoln d. Uncertoln 24. In or4w that you c glo clear o picture aa pa .. lltlo of whet you saw, we waul4 IIIIo for you to Imagine that yau could cantruct tho oltlact that you saw. Of whet ty,o ntatorlol woul4 you ... ~a. It? How largo would It Ito, and what ahapo waul4 It hoo? O.acrllto In yaur own word a ~oiNfton altfact or oltlacta which when plococl u, In the ally would give tho omo appooronco tho oltlact which you liN' / rJ J -IPd 25. WheN were 10u locot.tl whett 10u sow the oltlect? (Circle 0...): o. Inside o bull41ng n.outCTOOf~ 'd; Jn an airplane 26. Were you (Circle 0...) .!1-ln the business section of n city? U.. In t~!...!eltCTentllt ajc~fJI_cltr? ' c. In open countryelcle? d. F I ,-ing near on owfleld? e. Flying ewer f. Flying ewer open country? 27. What we you dalftl at the tl e you sow the oltfect, and how did you happen to notice It? 28. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the fa11owing questions: 28.1 Whot dfrectlon were you moving? (Circle One) o. North c. East b. Northeast d. Southeast f. Southwest h. Northwest 28.2 How fast were you moving? ---------miles per hour. you stop ot any time while you were loolclng at the object? (Circle One) Yes No 29. What direction were you looking when you first lOW the obiect? (Circle One) c. East e. ~uth lt. Northeast cl. Southeo1t f. Southwest 30. What direction were rou looking when you lalt lOW the obiect? (Circle One) a. North c. East e. South h. Northwest b. Northeast d. Southeast (f. Southwest) 31. If you are familiar with bearing terms (angular direction), try to estimate the number of degrees the object 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 28a b. From horizon ti'o 31.2 When it disappeared: a. Front true North _z; z_o degrHs. b. Front horizon 4 r degrees. 32. In the follow I,. alcetch_. IIIIDtlne that you :tre at the point 1hown. Place an A" on the curved line to show how hlth tho oltiec:t was a~Mtft tho horizon (1lcyllne) when you llrst aaw lt. Place a a on tho nmo curvecl lintt to ....... how high tho oltioct WOI a~e tho horizon (1lcyllno) when you fast 1ow lt. 33. In tho following largof 1lcotch place an A" at tho poaltlon the obtoct waa when you llrst saw It, and a "8" at Ita position when you last 1ow lt. Refer to amallor sketch as an example of how to complete the largof alcetch 34. What were the weathet condition at the tl.-you 1aw the oltiect? 34.1 CLOOOS (C lrcle One) a. Cloor sky <f. ScatterJ. c]o\idi) 4. Thiele or heavy cloucla e. Don't rememher 34.3 WEATHER (Circle One) it. Fog, mist, 01 light rain c. Moderate or heavy rain e. Don't .rente 34.2 WIND (Circle One) o, No wln4 It, Slight ltreeae c. Strong wind 34.4 TEMPERATURE (Cin:le One) . Don't rementl:ter 35. When did you report to 101M official that you had seen the ol.fect? Ooy Month Y oor Was onyone else with you at the time you 1aw the obiect? (Circle One) Yes IF you answed YES, did they see the abfect too? (Circle One) Yea No Please list thew nomes and addreues: 37. Wa this the first time that you had IHn an ohfect 01 oltiects lilce this? (Circle One) 37.1 IF you anawered NO, then when, where, and under what clrcumstanc did you sH other ones? 38. In yow opinion what do you think the obiect was and what might have caused it? 3P, 0. yo thlnlr rov c the 4 of the olttect? IP you Oftaw~rod YES, th what tpeM wo..ld you oatl,..te? ~0. Do yo thlnll you can ostfMGto ltow for oway fro"' you the eltloct waa? IF you answarocl YES, then how far owoy would you aay It woe? 4 'Piooao 11vo tho follewl"' 1rotl011 What Ia your proaont lola? S.x f",Al6 Plooao lnclicoto any apclol oclucotlonol tralnlnt that you hov hod. Grado achool --------- L. High school v _ c. Colloo Ae#f''J(A/ d. Poat graduate --------- T ochnfcal achool /JJ'..~,.; r(l.'/~ l'o 1--y I 6 C./1- (Typa) JSIF1tHk,t ~ / ,H(f{t,. ~Jo/t:.-.. f. Other special tralnlnt ----------