PROJECT 10073 RECORD CARD 12. CONCLUSIONS 2. LOCA'TION 0 Was Ba lloon . , : ' 0 ProboblyBalloon 3. OATETIME GRO'JP . Q,Ground V1 suol 0 Groo.mtf-Rcd a r 0 Ai rlntcrc:ept Rodor Probably Aircraft Possibly Aircraft Was Astronoml col ProbaLiy A:;tronomicol P ossibly As,ronomicol '/. LENGTH OF.03SERVA'riON 8. NUMBER OF OBJECTS 10. BRIEF SUMMARY OF SIGHTING ln surlic:icnt Ooto for Evoluo tion 11. COMMENTS s. A!R FORCE l'IECHNICAL lNFORMATIOH SHEET This ustionnoire h:a b.,~n ~roparod so that you C'ln givo th e U. S . Air Forco as much lnfamal ion as poss!blo concerning th~ unldentlfi~d aorlol phenomenon that you have ob,<Jrved. Plea$~ try to onswor oa many quastiona as you possibly c:an. Th, lnformotion that you giV$ will h~t vu~ ;"' : 'l'i~rch p urpoHtS; and w ill ~ rGgardod as confidential material. Your name will not b~ U36d : ,, C'J(')n;,ction wl til any !ltatem'.lnt, c:onc:luaions or publications without your pmluion. WtJ ro;~Ht this P<!rsonol information eo that, If It Is doomed noc:easary, wo may contact you for f~nh~r d~H~Ji li. Whn did vo' tho objoct? 2. limo of day: (Circle One): A.M. ot P.M. ( Cird-, One): (Circle One): o. Daylight Saving b . Standard 4, Wh~r.;, wor<J you whsn yo\J sow th~ objoc~? Neor Poatal Addrou .Addhionr.1l r.bmarks: S. Es t ;moto hew long you sow the obje:t. - C ity or Town Stote or Country 3 . 1 Ci tcfe on~ of th~ following to lndicata how c:..,rtain you are of your ant~wor t o Question 5. :::. Certain b. Fairly c~ri'lln (Circl~ One): Br i{lht doyl ight b. Dull daylight Bright twi I ight (Circle One}: o . In fronf o f you b. In hoc!~ of you T I) YOlJ( right c. Not very sure d. Jut a guess Just a traco of dcyl ight No trace of daylight Don't remdmber d. To your left .:. 0v'erhcoJ f. Don't re member Chors~ brig h tno .!is'? I< IIO't'tl Don'~ Know Don't Know D.m't Know O Fl:::k~r, th;-;,b, o; p-iho to ? 13. Did r}t., ob;~'=~ mov~ in front ov :~omo;hing at anytirn.t po:-,iculorly o clo Jd? Don't \<no\-!. 1F you on~t't""t2 YES, than to~ll what ( C irclo On~)! c. So!!d? b. 1 run;ncu~mt't c . D-ln 't !(now , ~. Blnocul::r~ 16. ToH In a few words tho foflowlng things obcut th~ obict. 17. Otow a pl,tur~ that wilt sho'H the shop of ?h~ o~lct or oblects. Lobel and lnclud In y:tUr ak~tch any datall1 of tht;~ ohjtc't thot you s-ow s uch aa win~.a, prottlijlona, tc,, ond sp.ci\JIIy "xhou1t trvll5 or vapor troll;, Plae ~., crrow biu ld ,;,,. drawing to uhow th dlrctlcn the obJ.ct woa moving. l9, Th-. edQ~J of th obiect wer~: (Circl.t o ,.,f?l): a. Fu::y cr blurred b. Like a bright ator c. Sharply outlined cl. Don't r~tmemb.r lQ. u: th'tre wo1 MORE THAN ONE oblect, thn how many were there? ----- ----------- Dra':'t a picture oi how they w~r orron~d, and put an arrow to ahow tha direction tnat they w~r traveling, ~C. Drow a plc~ure lhnt wlft show the motion that th obJect or ohlects mode. Pfoc" un t4A est thb b9glnnlng .,f 'h!t po1n, a "8" a t ~h" end of the path, ar.d .t,ow ony, chang~s fn dir~ctlon d-~tlng the <:ours. 21o IF POSS!8LEJ try to guess ot ,utlroote whet the r~Jal siu of the obi~ct wat in Its longeat dimension. 22. How larg~ did th~ obJect or ohjech op?Sa7 01 comport&d with on-e of tha following objech heliJ In the hancl ana ot obovt arm's !ength? (Circle One}: a. H~ad of o pin g. Sliver dollar h. BanbaJI Dime I . Grapefruit d. Niclt.et i. ; Basketball -lc. Other Half dollar :22.1 (Circf.e One of the following to indlcote h~w certain you art3 of yoi.X an!JW07 to Question 22 ~--~ Certain c. Not very sure b. Fairly e.tdoln d. Uneertal11 How did th~ ob~ct or obiacts disopp,cr from viow? ..:~: "'_;._--------~--------~....- 2 4 . In order that yov con glv oa cleor o f)ldur~ aa po .. lhle of what you aow, w would Wee for you to Imagine that yo11 could conatruct th .. ohlct that you aow. Of whot typ mot$1lol would you mo!ce It? How loro would It b, and what hope would It hou? Dnerlb fn your own word a ~ammon obtct or obteete which whn plac*CI up In the aky would give th aam opp.,ron: os t~e obj<~tct w~lch you ow, 25. Whcr~ were you located when y0u saw the object? ((ircle One): a . l11side o building b~ In a car c:. Outdoor s , nonci~;Jlone 26. Were you (Circle One) . o. In the business s ection of o c ity? b. In t he resid(mtial section o f a city? c. In o pon countryside? d. Flying naor an airfield? e. Flying ovt!lr a dty? f. Flying ov~r open country? 27. What were you doin!J at the t ime you sow the object, and how did yo u happen to notice it? 28. IF you ware MOV lNG IN AN AUTOMOBILE or other vehicle at th, time, then complet& ths following qu~stions: 28.1 Whot direction were you movil"'g? (Circle One) a. North c:. East e. South b. Northe a s t d. Southeas t f. Southwest h. Northwast 28.2 How fast were you movi ng? -----------mile s pe r hour. ?.8.3 Did 'fO'J stop at any time w hile you were looking at the object? (Circle One) Yes No 29. What dir9ction were you loo~ing when you first saw the object? (Circle One) b. Northeast f. Southwest ( h . . Northwest d. Southeast 30. What d irectio n were you looking when you last sow the object? (Circle Ona) e. South g. Wast d. Southeast f. Southwe.s t h. Northwest 31. If you ore fo mil;.:lr w i t h bearing terms (angular directio n), try to e stimate the n umber o f degree s t he object was from true North end also the numbe r of degrees it was upward from the horizon (elevation). 31.1 Whe n i t fi rs t appeared: a. f-rom true North ------degrees. From h:)rizon degrees. 31.2 When it di sapp~:ored: a. From true North ------degre e s . From horizon _ deg rees, 34. What we re tho weather conditions at the time you sow the object? 34.1 CLOUDS (Circle One) a . Cle ar sky c . Scattered clouds ~r Thick or heavy clouds . e. Don't remember 34.3 WEATHER (Circle On~) '-~ Fog, rnist, or light ra in c. Moderate or heavy ra in e. Don't remember (Circle One) a. No wind Slight b roexe c. Str ong wind Don't remember 34.4 TEMPERATURE (Circle One) e. Don't remember 35. When did you report to some offic ia I that you had seen th" object? 36. Was anyone else with you ot the time you saw the object? (Circle One) Yes ._liQ 36.1 IF you answered YES, d id they see the object too? (Circle One) Yes No 36.2 Please list their names and addresses: 37. Was this the first time that you had seen an object or objectS like this ? (Circle One) 37.1 IF yo"' a nswered NO, then whan, where, end under what clrc:umstoncos did you se. other ones? 38. In yoU:' opinio n whet do you think the object was and what might have caused it? 39. Do you think you can estimate the speed of tha object? (Circle O.w) I IF you an.:ower<Jd YES, th en what speed would you estimc.tte? 40. Do you think you can estimate how far a way from you th-a object was? (C i.-cle One) IF you answered YES, then how far away would you say it wos? feet. 41. Pl~ose give the following information about yourself: Middle Noml!t City Zone State TELEPHONE ~lUMBE Please in~ icate any special educational training that you have had. Grode school Technica l school b. High school c. College f. Other special training d. Post graduate 42. Dote you com;:>leted this questionnaire: Oov Month Year SL:.CURITY CLASSIF ICATI O N JOINT MESSAGEFORM SJ!J.OE JJEJ,(),V Ur:SJ-:UV f:IJ f'OR Cfl3t ,\(lJ.VU:.t 7'! (),, af;X 1"1-:ll CLA:.>$1 F ICA T IC"N OF RE:FERENC!! ACCOUNTING ORI G . Oft REI~t::RS TO BOOK MULT I S HICLE SPECI A L INST q UCTI ONS 20L,.6T'.cl A:\CS~tOrl H- P AFB OHI O CCHDB/ADC E:IT AFB COLO SP.RI:1GS, C0LO C~.J.\"tDR 3 0TII P.D '.III.LO~I HU:I AFS, 7IPSIL.1..IDI, diCa C<}iLDR .d'rlC, \~1UGRT-?AT'l'Zt:u>0:-4 A..i'.3, OHIO 0!.1IL) ;.SS r Ci:Tl<;_L;> QI1 ST.AFF, ItiTSLLI(rE!,CE, US.A.:.', '.1.~:1. 25, DC ~ HZADQUJ\.B.TEB . .S, USAF, HASHINGTOll 25, DC ATT:i: CF?IC:::!: tJF IU:iro SVCS U~JCLASS 2046FS-13-L-62 UFOB. A . (l) CV.'~ SfL\PED, (2) ~;u1' GIV!!:i-1, (3) BLACK & t.fHITE, ( 9 ) .APPEARED T0 GLOlA. B. (1) liOT GIVE.i'.J., ( 2 ) BETIIEE!'I 300 &. 400 FT vVER PI QUA, OHIO, (J) BZTif-.!:.3:.1.'1 3 CO & 400 3'1 f\..PPEARED TO BE CLI1-!;JHSG, (4) HOVING SLOWLY 2-10RT'J , ( 5) SL0 :1L 1 TO TilE NOR Til, ( 6) THREE OR FUUR SECO\IDe MONTH YI::AR IJ CL -I.r"'IED S I GNATURE J~tl:;tlnt.:::tr. tlon R !::PLI\CE:S 0 0 FORM 17::1, I OCT '-9, Wt~ICH WILL-E USEO UN71L E XHAU!'r:!O