t. DATITI ... IIIOUP t. LOCATION Cinc.:i.lUl' .ti, Ohio J. IOUttCI I. LIMOTM 011 n. MIIP MMIAIIY ... 6. TY'I OP OUIIVATtOM 9. '"YIICAL IVIDIMCI FTD lltta U. I. All POICI TICHHIC~L IMPOIMATIOH SHIIT In ordwt tt.t your .. flle4 ClfMI cocle4 aa accurot.ly aa po11lble, please use the followlnt 1pace to write out ahort deacrlptlon of the went thot you obaerve4. You may, .. a. thet yeu '- aiNady tlven In the queatlonnalre, oncl acid any further comment a, 1 , etchea that rou kllwe are Important. Try to preaent the detolla of the obaera- tlen In the order In which they occurred. Aclclltlonl pagea of the 1ame 1l1e popr may be ottochecl (Do Not Write In Tltls Space) SIGNATUR TICMMICAL ~MIIORMATIOH lhlt .,.etlonnolre has Mlft "''re4 10 thot you con give the U. S. Air Fwce at much trtfarmotllft at p011lltle cencernlnt lhe unidentified oerlol phenomenon that yov hove olterve4. Pleote try to ontwer 01 many qVIttllftl 01 you pouiWy con. The lnformotlon that you ole will be vtecl for rne1rch ,.,..,,,. on4 will -reeorcld 01 confidential material. Yevr nome will nof In cnctlon with Y , conclvtlont, or publication without your permlttiM. We requett thlt pereonol : . ~ lon 11 lttot, If It It ciHmecl nec:euary, we may contact you few further cletall1. When did yov the oblect? Time of cloy: (Circle One): Time aone: (Circle One): ~ Egtt;;ft) o~yi)Qi!t SCIYi) (Circle OneJ: CO~ lt. Central ... Where Wife yov when you tow the oltiect? ~:.oe C..Av~b\J~kl Hoerott Peetel A reu City or Town Stet ., Ceufttry Additional remerlct: 5. Eetlmote how lang you eaw the oi.Ject. Clrele OM of the followln1 to lntllcote how certain you ore of your antwer to Quettlon 5, o. Certain Not Ylf)' IVfl ~ Fa~r cer,.lj> Ju1t a gueu What wat the candltlt~t of the ally? ~ _Just ~!race of dorll;_iit> (Circle One): a. Bright cloylltht b. Dull daylight No trace of doyhght EJrloht twlll~t f. Don't remember IF you aaw the oblect clur~nt DAYLIGHT, TWILIGHT, or DAWN, where wat the SUN located ot you loo~ed ot the oblect? (Circle One):~ In front of_you) f"u \..\..'i ~E.T. d.. To your left b. In baclc of yau 0'~ L\ ~ \o-\T Overheod c. To your right ~'T\Lt.. W ""~ f, Don't remember RE:MIIo.~N\N"'. I. IF Y w .the oa.tect et NIGHT, TWILIGHT, DAWN. wh.t tlhl you notice concnlng th.-STARS and MOON? L1 STARS (Circle 0...1: 1.2 MOON (Circle One): ~Brig~ m~llthtJ Fv LL. l'V\ao\'\ ~. Dull Moonlight c. No moonlight -pitch dark d, Don't re temler 9. Waa the ollect lwlghter than the ltaclcpouncl of the alcy? (Circle One): ... No c. Don't remern.,_ IF It wet BRIGHTER THAN the alcy ltoclc .. MI, wee the lwlghtneas lllce that of an outomoltlle heaclllght?a (Circle One) A II fftOfe away ( distant cor)? ~. S.v!'al awarP c. A bloclc away? 4. Several yorcla away? 11. Did the oltiect: to atoncl atlll at any tlrne? lt. Suddenly a,..d up ancl ruth away at any thne? c. 8rectlc up Into porta explode? 4. Give aff 1 male? Change lwlghtnett? f. C'-'o ahape? I Fllclc, thralt, or pulaote? (Circle One lor eodt questiOit) Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know 12. Did the obfect ~eWe "-hlncl ao1111thlng at anytitM, particularly cloud? (Circle Ortel: Yea Don't Know. IF you answered YES, then tell what 13. Did the oltiect move In front of lng at anytiMe, partlcuiCifly a cloud? (C lrcle One): @) It moved In front of: ""'" Don't Knnw, IF you anawered YES, than tell what 1~. Did the oltiect appear: (Circle One): 1. T ranapCit'ent? c. Don't Know. Dlcl you obaerve the oltieet through any of the follvwlng? Binocular a Sun glauet Teleacope Yea Wlnclshlelcl Theodolite Yet Window glou 14. Tell 1ft t.w I tt. fellwlftl thlftll ..... h eltieet 17. Drew ,teture lhet wth tt. ef tM eltfMt eltfectt. Let. I end 1Miu4e In your l&tch ony 4tetl tl... thet,.. ewch , .. ,.,._,,etc., on4 epec .. lly he~at troll or vopor troll a. Ploce the ....... te 1hew the illrectlen lite ..... , WI "'""'" 1L The e4 .. , of the olllect were: {Circle Otto): 19. 1P wea MOR! THAN ONE _,ect, then how ... , were tlsre? O""u---< 0 ~\i=o- Drew o ,aceur. ef hew titer.,,. ..,....4, n4 put errew to ahew the direction that they were trovellftg 20. Dravr picture th11t will show the motion that the. obioct or obioctl mode. Place an A at the leglnnlng of the path, 'a a at the end of the path, and show any changes In direction during the course. 21. IF POSSIBLE, try to guess or estimate what the real tlae of the oblect was In Itt longeat dimension 22. I low Iorge did the oblect or obiects appear as compared with one of the following obiectl heiJ In tlte ltortd end at at.out ornt' length? (Circle One]: a. Head of a pin g. Sliver dollar h. Baseball c. Dime I. Grapefruit d. Nlclcel Baslcetball e. Quarter lc. Other . f, Half dollar 22.1 (Circle One of the following to Indicate how certain you ore of your answer to Question 22. (i. ~ertaln) c. Not very sure alrly certain cl. Uncertain 23. How clld the oblect or obfecta disappear from view? C. C't.o 1!.S> T':\ S. F,...c..e:. 0 ~ THg; 24. In OJ4et that you con tlvo cloOf a plcturo poulhlo of whot you saw, wo wou14 lllto fOf rou to IM .. IM thot you could construct tho oltloct that you aow, Of whot typo Motorial would rou molto It? How Iorge woul4 It Ito, ond what shepo would It hen? Doacrlho In your own words a hmmon ol.foct w oltlocta which whon pleco4 up In tho slty would glvo tho appooranco oa tho oltfoct which you saw. (THE L\c;..HT OF THE c EC...T UJ,. D\~T\NC...T W\TH No Be:. OPAque_. 25. Whet.' ware rev locate4 when you saw the olfect? 26. Were you (Circle Onel (Circle 0.1: In t.,elt~l!el.l.JtcJJoJLcd.LcltJ7 ~ In the residential aectlon of a ct_i?) c. In open coVntrytldel--- 4. Flying near on airfield? e. Flying over a city? f. Flying ewer open covntr,? 27. What w rou 4alng at the time ,ov lOW the oltlect, and hew 4111 you happen to notice It? 21. IF JOV were MOVING IN AN AUTOMOBILE or aliter vehicle at the time, th.n complete th .. following quettlont: 28.1 What direction were you ~nWing? (Circle Onel a. North c. Eaat lt. Northeost d. Southeaat f. Southwest h. Northwest 28.2 l~w fatt were you mcwlnt? ,;....... ~niles per hour. 28.3 Dlcl you atop at any time while you were loolclng at the ol.iect? (Circle OneJ Yet No 29. What direction were you loolclng wheft you first taw the obfect? (Circle One) lt. Hortlwatt cl. Southeast . f. Southwest h. NOr wett 30. What direction were you loolclng when you last taw the ol.lect? (Circle OneJ lt. Northeast f. Southwest h. Northwett 31. If you are familiar with l.earlng terms (angular direction), try to estimate the number of degrees the obiect was from true North and alto the n'""lter of de .... It wat upward from the horizon (elevation). 31.1 When It first appeared: lt. From horizon 4 " clegr .. s. 31.2 When It disappeared: a. From true North --dllf lt. From horizon 4-~ 32. In the fell I .. tketch, llftlltlne that you ore ot the point shown. Ploce an A on the curved line to a how how hlth the tltiMt wet aiMwe the horlaoe (skrllne) when rou llrtt saw lt. Place a a on the ant cuned line to ahow how hlth the oltlect was oltove the horlaott (slcrllne) when you latt saw lt. In the following larger sketch place an A" at the position the obiect was when you lirJf 1aw It, and a a ot Its poaltlon when you lost lOW It, Refer to smaller slcetch as on example of how to complete the larger sketch. og, lftlat, light rein c. erheavy rain Den't ren 34.4 TEMPERATURE (Circle One) 3S. When dhl you to ..... efflclal that you had tMn the oltlect? l6. Waa enyan elae with you at the time you aaw the o"tect? (Circle One) @ Ne . 36.1 IP you anwrcl YES, clld ther '"the oltlecf too? (Citcle Otte) (Yea) No 36.2 PleeM lltt their end eclclre~tee: 37. Wee thle the flrat tiiM that you had eHn en ol.lect olttKt lllce thla? (Circle One) Yea ~ 37.1 IF you ensware4 NO, th. when, wh.re, eftll uetel~r whet clrcumstancea did you '" other onea? 38. In yow opinion what do you thlnlc the oltlect wa1 and what might have cauaecl It? " Do Jlhlftlr JOU cott ottlte the apooflof the oltloct? fCircle One) (!';) No IP y.-ontwe YES, wftot ,,... wovlcl you ettiMOte? o. Do r thiM you can ottiMGte how fer away from you tho ol.ioct wet? CC lrcle One) <Y!j) No IF,., entwerecl YES. then how'-away woulcl you,., It woa? 41. Ploale .... tho fellewl"' TELEPHONE NUMBER Whatlayour PleaH Indicate any tpoclal oclucotlonal training that you have hacl. Gracie tchool $ "(~ 1! . lt. Hlth tchool ~ ~ (\-., . e. e. Tochnlcoltchool Ae~o c'" Nl'l.~. I~"''"' cl. Pott gracluato ----------- f. Oth tpoclal training A'-'"'-J'\6-N G aT 42. Date you co tpletocl thlt quottloMGire: