1. DATI TIMI GltOU' J. SOUitCI NUMIIIt 0' OIJICTI S. LINGTM 0' OlllltYATIOM 6. TY'I 011 OIIIIYATIOM 1. ' ltHOTOI 9. PHYSICAL IYIDIMCI FTD "' ts 0-32t (TDI) L LOCATIOII AND ANALYIII U. I. OICI TICHMICAL IMPORMATIOM IHII T Thlt quettlennelre hot ~"" thet you can elve the U. S. Air Force o lnf,..tiM at ,.ttiWe CIMifRiftt the ""ltlofttlfl .. aerial phenomenon that you hove Pleoae try te antwer NftJ ttttiMt yev 'ottlltly ec~n. The Information that you 1 will .. uted for retMrch ,_,..,,,. ofl4 will M ,. .. ,._. 01 confidential material. Yo"' ,..,.. will not Ito uaed In conn1ctiM with afty ........ ,,. .. , conclutiMt, or pultllcatlont without your pmluleR. We requett thlt perttfttl tftot, If It It ciHmecl neceeaory, we may contact you ftr furth cletolla. When dlcl you tee oltfect? 2. Time of day: Hour MlftVtOI (Circle One): 3. Time zone: lt. Central c. MountoiR 4. Pacific Aclclltlonal reiNt'lct: 5. Ettlmato how lone you tow tho oltfect. (Circle One): a. Darlleht Sovl"l Cltr or Tow" 5.1 Circle 0110 of the followfftt to ln41cote how cortoln you ore of your antwer ta Quettlan 5. lt. fairly ctwht .t. Jutt a eueu 6. What wat the conclltiCift of the tlcy? (Circle One): Bright claylltht -:) iUlnGiflilit- - c. Bright twllltht cl. Just a trace of daylight No trace of daylight f. Don't re1111mlter 7. IF you taw the oltlect clutinl DAYLIGHT, TWILIGHT, or DAWN, where wot the SUN located at you loolced at the obiect? (Circle One): a. In front of you lt. In ilaclc of you c. To your rleht e:-OverhH"d f. Don't remember I. IF you aew the olalect et NIGHT, TWILIGHT, or DAWN, what dii you notice concnlng the STARS and MOON? 8.1 STARS (Cirele O...Ja . 8.2 MOON (Circle One}: Don't re er Bright moonlight Dull moonlight No moon I ight -pitch doric Don't rememt..r 9, Woa the oltfect llflthter the" the ltecktrewncl of the Icy? c. Don't rememiMtr 10. IF it wos BRIGHTER THAN the alcr Hc:lc .. uncl, was the ltrightneu like that af an autamolaile heacllight?: (Circle One} a. A mile fW more away (a diatant cor)? b. Several ltloclcs away? c, A block away? d. Several yards away? 11. Did the object: (Circle One lor each qu.stion) a. Appear to atoncl atlll at any time? b. Suddenly speed up ancl ruah away at any time? c. Brealc up Into porta ot explode? d. Give oH smoke? e. Change brightnell? f. Change shape? I Flicker, throlt, ot pulaote? Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know 13. Did the obfect mwe In front of aomething at anytime, particularly a cloud? (Circle One}: Yea ("No ... -'} Don't Knnw. IF you answered YES, than tell what (-'-Solld?J 14. Old the obiect appear: (Circle One}: b. Transparent? c. Don't Know. Old you obaerve the c*iect through any of the following? a. Eyegloa1e1 Binoculars b. Sun gla .. ea f. Telesco,_ Yes c. Windshield Theodolite Window glo11 16. Toll 1ft a few worcla the fellewlnt thlftll ela1ut the alaiect. 17. Draw a picture thot will ahew the of the altlect or olafectl. Lalaal encllnclucla In your alcotch any cletolla til the olaioct that yw aew wlnp, pretrvllaftt, otc., an4 oapaclally axheuat troll or vapor trail a. Ploco em arrow ~a. ... the diewlft1 te thew the tllrectiM tho oltiect we mewing. cl. Don't rama111llar 19. IF thoro waa MORE THAN ONE oltfoct, th how wore thoro? ------------- Draw a picture of how tho, ware Nftgatl, and put an arrow to ahow tho cllroctlan that they wore travollnt 21. IF POSSIBLE, 1r1 to gueaa whet "'-rHI tile of the ol.iect WOI In Ita longeat cll entlon. How Iorge d hi the oltlect fl oltlecta oncl at a &out flffft (Circle One}: 4. Nlcltet f 'Hctlf 4oll with on of the following oLfect bell In the honcl Sliver dollar h. Baa.NII Grapefruit Baslcetlwlf c (Circle One of the following to lnllicote how certain pu Ofe of yow answer to Quettlon 22 c. Not very twe cl. Uncerto.ln . 23. How ciW the ol.iect olttec cl 24. In ortler lloet rev tl cleer plelure.ea peeeiWe ef whet reu eew, we wevltl lllao fer jeu te tiM thet ,.v cMI4 conattHt the eltfect th re eew. Of whot trP riel weultl rv ..... Itt How 1-.o wevl It '- OM .wh.ot eho,. wovltl It howo? DoaIM In row " r o ~e ........... ., oltloeto which when ,t .. e4 up IR tho alar wovltl ''"tho 25. Where were l~e.tl wheft ,.v sow the oltfect? (Circle 0...): Ina Ide a ltulltllf'l Ia. In a car d. In an airplane 26. Wore you (Circle One} a. In the bualnesa s\lction of a cltr? ,. , &. In th.risldlnt1Cir;;;tl~ of a ~i!Yl ~ - c~ln O,iricovntr;.;ide? - d. Flying nr e~n airfield? Flying O'tfl'l a city? f. Flying fNef open country? 28. IF you were MOVING IN AN. AUTOMOBILE ~ other vehicle at the time, then complete the followint queatlons: 28.1 Whet dlrectl were r- lt. Northeast '"'' (Circle On) cl. Sautheaat f. Southwest 28.2 I low faat wara rou mavi,.? ---------miles per hour. 28.3 Did you atop at any tl whll, yw were loolcln1 at the object? (Circle Qaa) Yea No h. Northws t 29. What direction were ,.uloal&lftl when rev firat aow the obiect? (Circle One} lt. Northctaat f. Southwt h. Nartftwea t 30. What direction were yeu loal&lftl w'-' rou laat aow the oltiect? (Circle One) a . Harth c. Ent e. South a,, Northeast tL South .... f. Southwest 31. If you are falllar with a.,.,.,. from true North and alao the (-.ul direction), try to esthnat the nwnber of dei'"' the obiect WGI of ...... It was upward from the horizon (elevation) a. frOM true Nari C.:/(,) tlor b. From horlz ---.o~z~a--. .... 32. In the foltlne etch, I th.t yM eire at the point ahown. Place en A on th. cu"'ed line to ahow how high the ~ec ... we the hwl (al&yline) wheft rov flr~t aew lt. Place a ... the .,.e curved line to ~bow how hlth the .... , wea ...... the horll (yiiM) wheft you lest aew lt 33. In tho following lor.., alretch ploce A at the position the oltioct woe when you firtt saw It, ond o a ot Ita poaltlon whon you le1f 18W lt. Refer to amallor tlcotch at on xo~nple of how to c the lwger alcetch Oo yov think you C'an e s timate the spe'!tl of the objttr.t? (Circle On.,) Yes IF you answered YES, then what speed would you estimt1te ? 40. Do ) 'IJU think you can ftstlmate how for ~)YOY. from you the object waa? (Circle One) Yes No IF yuu answered YES, then how far' awaywould you say It was? 1 41. Ploase give TELEPHONE NUMBER .J-r- ... c I I Jlj/'' I -I Please indicate any special educational training that you hove hod. a. Grado school e. e. Technical school------------- Dote you completttd this questionnaire: 'l f-<' r S ~ _ Day 1"./'MOftth Year U. I. A II P 0 R C I TICHMICAL IMPORMATIOM SHIIT (SUMMAII'f DATA) In ercler thet rw lnr.Ntl r t.. flle4 en4 ce4e4 accwately ,. .. Uti, ''" .. u .. the fllewl"t 11 te write eut at.t d.ecrl,.len ef th event that you oltnrve4. Yeu ,..., , .. peat tnfer-'811 thet yau hat alredy tlvn In th t~uettlonnalre, and ocld ony further caMNnta, atatemante, al&etciM thet rev tt.ll"e I Try to pr the detail ef the ~erve tlon In the erder In wltlch thr Dc:rurr.d. Addltf1~1l ,. ... ef the IOMO tlae P~tr "''' H atteched If they ora nedad. c.' (Do Net Write 111 Tltl Space) SIGNATURE-