P~OJ::CT 10073 F~ECORD C/\~U 2. LOCATION 1:!. COlCLUf.IO:l.> c~ Woo> BolloMI 0'1l.o 0 Probohl y BJIIoo' 4. TYPE OF OI:IS!iRVATION :c Gro,.nd Vi suol Cl Croun<I-RmlrJr 0 1\ir-lniNeopr Rodor Wo~ Ai rcrnf t Probably Aircraft Po,.sibly Aircrofr Was /<:;:ronomo cc.l Probably A-;lronomocol Possibl 'I Astronomicul 7. LOICTH Or OJSERVATIOI'l O. ~lU.\BER OF OBJI:CT S 9. COURSE 0 lnsvlficient Octo for 10. GRI!:F SUo.IMARY 0~ SIGHTING 11. COM\IENTS st. tinn~>ry JJ irlhr.: I h:lll ,') lP. rJ i.c(c: t io:1 ATlC FO~'oC Jl~ (REV 26 SEP Sl) In ordt.:r that your inforrno~ion n<oy bo filod and c;oclcd os occurntcly os p.:>ssible, please u~t. the !ollvwin~ ~pace t o writ~ out o short d~scripti->n o f the event thu t you obH.rved. iC'u rnoy ru- p~'l i . .formotion that you have ~dr-:ody given in thu qufl~ti<Jnnoire, anc.l odd .;ny further c vmr1'erds, s:oJI~:nents, c>r skotcht:s tlwt you beli.,ve oro irnport ont. Try to prosor-t the datoil5 of the obsorvo- t on in tht> ordor in which th~y oc;r.urr~d. Addit1vnol pogas of tha s o1n" s ize P<JP<H may b~ cttochoJ iF they oro needed. (Co Not w,ite ;,, This S;JOC\!) (PI euo;e Prir:t) lJ. S. ~I R F 0 n C E 1 E C H t-Il C A I.. I ll f 0 :n.t A n 0 N SHEET Thla quc~ :ltionnoirJ has b n pr-:>porod ~o that you con giv..l th..l U. S. Air Forco ens rtl.i ... h lnf.J,"lltion O'\ pos:Jibl., concern ing tha unid.mt ifi.,d oerlcd ph.momtmon thot you huv" obJr,a<J. PI )<l'i:t try t o on:;w~r as mony q uestion:~ O J y-:lu pos:1ibly c on. Tho Jnform<Jtion that you givo will b., u l.,d for t<>soorc h purposus, and will l;.., rvgard11d cu confici.,ntiol motoria l. Your nom' will no1 ) 'J 1erd in connection with any ~totement:s, cone:! :~ ion!.\, or publicot ionl witho,;t your pormbsion. .,.;, r:;,qv~st thl:~ ~rsonol info;motion JO that, If it I t~ do.,rn-ad n.:tcCt\:lory, w., moy c ontact you for fuOh'lr dl)tails. 1. Whon did you s e e the objl3ct ? Do y Morj1n 3. Tlmb xcru: (Circla On{): o. Eostar0 \..: fs-:-contial c . Mountain d. Pacif ic the obj~c t 2. Tim!! of day: (Circ/6 One): o. Doylioht Sovinv b. Standard Stolt7 or Coun rry J.~d.!rionol romorks: 5. EJ ~imot-ct how long you sow the object. 5. i Cirda ono of thb following to indicoh how c :moln you ora of your answ,, t o Qu,ution 5. '-- b, F o irly c erlo in c . Not V<Jry suro d. J u.Jt 0 0U')H {Circle One): o . Bright doylagh~ .- (,--{1 .'\ d. Just a trace of daylight b. Dull daylight c~(/,_:...:-..: ,t_.) o. No trace of da y li!Jht c. Bright twilight - - -f. Don' t remember 7 , IF you sow tho obj oct du<ing DAY LIGH f. ;~ ~ f~ ot DAWN, wh>to wo' t ho SUN loc~;:,d a' you f. Don' I rumomb.,r ( Circle Ono}: a. In fro11t o f you b. In bock of you c. To you: right 8. IF Y'u Htw th ouject, at NIGHT,(l I_LIGiJ_T r<>/ DAWN, what dirl yc-u nolic.:> conccrninq t',) STARS l:'nd M00!-d 8.1 Sf .\RS (C irclo One): 8.2 ~.\Om~ (Circl? One): CJ, Non-.;=) .b. A ft!W a . Bright moonlight b. Dull moonli3ht d . Don't remomb~r c. No moonl ight -pirch dar~'< Y. \'los tn<t ob " c t brigh~ar than the bcc~round of th~ ~ky? 10 , IF i: was BRiGHTER THAN t ho sky hockgr,und, we~ tho br;ghtn~H li>.;, that of on outomobll~ h,odliS!:,t?: (Circ/9 0.1c) a . A mils or mortt owoy (o d! .. tont co,)? b. Sovcrol bbc c . A block owoy? d. S..tvora I yards r:woy? Old lh!l obj(!ct: .-(.C irclo One for e~ch qugsfion) u. Appecr to stand still atony t ime? b. SL.:! nly spcad Uj) and r ush owoy o: any tim'? c , Orl)o~ up into ports or explode? d. G ive off smoke? u. ChCinge bright nes s ? f." ChanJ<l shape? g . Flick :, throb, or pulsate? Qo3 J No Don't Know Don't Know Yos C!.fi() Don't Know Yos l~o Don' t Know Yo~ J'~ Don't l<now Yes .:_tt~ Don't Know "Yo:s _tlo Don't Kr.ow Old t he object move behind :;omathing at onytim~, particularly o cloud? (Circl~ On~): Yes No ' Don't Know. IF you onsw,rfJd YES, t~en ~ellvl,o; 13. Did tho obj~-: -:: :: in front of somath!~t anytime, particularly a cloud? ( C ircl" On.: Yes (, .... lo / Don' t Know. IF you on..sw.:>r.ld YES, than t~ll whet 14. Dkl th . ., object appear: (Circi:J One): , o . So lid? ..,. b. Tron3porcnt? c. Don't l<no.,. d you ob:;orvo tho objoct through any ol lfit> followlnJ? I ' o. Ey''l:lln ~-;oo:: Yo:l No o . Gint>ciJicrq Yo~ No c. Vlind~hiulcl d , \'{jo,dow gi01!:S f . Tolo .. copo Yas I No (Cirr.:/1 On1): CJ, Fu: zy or blurr d c . Sh=,ply ovrl hed .. ..-cr.-D:m't rcm<lmb~r 0RE THAN ON= obje-:t, thon how motl)' Wuro th~o? ~------------------ 20. Oro...,. o picturtt 1hot wlll s how the motion ?hot ~net obb c t or obj9cts ~ad.,, Pl1c:, an "A" a l ~he b.,ginnlng of :ll path, a " 8'" o t thiS ond of the path, ond 3ho.v any chong~"' In dir..,ctlon clldng th! cour s.,. IF ?OSSIBLc, tr y t o guess or e~tlmotrwhot th: t-3o~ Lte o~J:~ '~bi~ct wo!l In lt.s long.,3 t dlm.,n.lio~. How Iorge d id th~;t obj~ct CY objac h ap?'3ar a3 compared \Yilh one of th11 following obj"c.h beld in the hand o nd a t abou~ ar m' s bngth? ( Circle One) : Silver dolla r a. H.,ad of o pi n g Bo:serball Gropttfruit Bo:. k" tbo II Quarter k. Half dollcr (CircltJ Or ~ of th, following_t o i.n~icote how c0rtaln you ore of y o1..r anJWtH t o Qu~.sllon 2 2. r:;, Cor~gjo, :.) c . Not very :sur., /' b. Fairly c~rtoln d. Uncer tain r--{ I How did th') ob!ect or obj~ct:l di-s -op_p_"_o_r--f,-o--m-.;,-i"_w_ ? , ----~- &-,,~J.t.lAI 2.J. In o rd e r tha t yov eon glvlt oa door a plc l vt .t o:. poulbl of ...,hol y,v aaw, w, wovld like for y.,u to lmoglnlt !.tot ~ou could col"t truc t thtt obi c t t "tot you saw. Of ~',or tjptt mot .. riol would yov mole .. It? lb~ Iorge would II h , on<! what ~hope wovltl It hove ? Descri~" In yovr own wo rd;a o common obJect o r ob!och which whn place d up In the 1l<y would g l vo th~t lOme Oppe OrOOC 0\ I no obje c t Whi c h yoV lOW, Wlwr! w n~ you l ... ,.,~tkd wlt.:n y-.~u s,n, th oh1cct? (Circle One). r a. Ins id ~ o butld1ng h. In o c:ar d . In 1n oir;ll nne c. A~ !lt:O 20. Wo:rt: yc 11 (C1rc/e One) In thn bus incss scct1011 Ctt u city? In the rc:sid.mtial !>"clie>n of r'J city? rn oper-:c;uni;;~i J~? . Flyin~ r.J.:H on airfield? flyin~ over a city? Flying o 1er open country? 27. What 1crc '/ou do ina ot tha time you sow th.-: ob1ec t , rmd how diJ y<>u h.1ppun to nQtice it? ?.8. IF y.lu were MOVING IN AI~ AUTOMOulli: or other vehicle ut t h.: tim!:, then compl~i.: tne fcllowinJ qu.:sr;on'S: What direction were }'OU movina? (Circle 011e) a. North c. Eos t b . Northcost f. South.vc.:st 28.: How fast were you m~ving? --------- mi lc:; per h:>ur. Did you stop ot any ti rne while you w<:ro voking at the obj~ct? (Circle One) Yes What direction w o re you looking when you first saw tho objcc t? (Circle One) e . Sol!th b. North~ast d. South.:lost f. Southwest 30. What d .rection wer e yot..o lo~'<:r.g .vh!!n you lost sow the object? (Circle One) "c. ~lort~ :>. Northeast c . E O S t d . Southeast h . North.v:st h. Norrhwcst h. Northwest 31. I f )'.:IV:" i.J.~t!ior with bearing te rms (on!'julcr dir..,c.ti~n), try to cstirrat~ the n~.lln~r of d!gr-::.::c; th<;: object wo.;; : ~ :>r!n and also the numb"'=' of rl"s:;.;c-; it was upward from th.: horizon (~levation). When i t f irst oppeMcd: Fr:n tru~ drgree s. From horizon _ degree 3 . i I d i sopp~.:or!d: Fro m trtJt: t ! ) T fh c:eqrc~'i. Fr'>lll "r,r it:Oil 34. Whut were the weather conditio :> at the lirne you saw the object? (Circle One) (C irclo Ont!) a. C lcor sky Slight brce2~ c. Scattered clouds c . Strong wind cl. Thick or hl:)ovy clouds Don' t rcm~mber e. Don't remember 34.3 WEATHER (Circle One) 34A TEMPF.RATUP.E (Circle One) : '--b-; ... fOg, mist, o r light rain c. f..\oderote or heavy rain e . D o n ' t remember e. Don' t remember 35. When d id you report to !;Ome officio I that you hod. sc1en the obj.;,ct? 3.6. \los anyone else w ith you at the time you sow thu obj~ct? (C irclc One) 36. 1 IF you answered YES, did they see the object too? (Circle One) Yes No 36.2 P!ecs~ list their names ond addresses: Was this the first t ime thqj...you hod seen on object or object.i like t his? (Circle One){ ) No 37. 1 IF you answered NO, t h e n when, where, and under wha t circumstances did you see oth !!r ones? 38. In your opin ion what do you think the object was a nd what might hove-caused it? :YY. D..:> yo u think y o u con e s t imate the spee d of t h o bjitc t? ,Circle One) IF yo u an~w~red YES, t h e n what ::peed would you o:;t imate? Do y o u th in k y ou can e s t imate how fo r away fro m y o u t h ., obj.tct was? IF y o u onswer"'d YES, tha n how for away would y ou :;a y it was? .:..-------- 41. P loosa give t ha following information a bout yoursolf: Middi!O N o.-- ~'--. -Z on:!lt J Stottt TELE PHONE NUMBE Whot i~ your present Please indicate any spcciol.educationoJ~troining tho t you hav~ had. o. Grode school ) .J.- ~--" o. e. T echnicol s c hool d . Post g raduate ----------- 12 . Dote yo u completed this q uestionnair e : f. Othl:r spec."io l trai ni ng--------------