2 . LOCATION _ CONCLI:JSIONS .C. TYPE OF OBSERVATION a. lil .. .a }{KGrouncJ. Visual 0 AI,.. Vi suol lCN-CTH 0" 08 Ci vj.Jinn HUMBER OF OBJECTS 10. 13Rtf' SlJMM"RY OF SICHTIHG ~, d i .: g-reen o n left. No 1Ld .,e dis t i n guished \ \\ NCept Radar Was Balloon Pro ba bl y Balloon Possibly Balloon Wos AI reraft Probably Aircraft Possibly Aircraft Was Astronomical . p r o b obi y Astronom! col Possibly Astronomtcal ~:fflcient Data for Evaluation mine d to b e a / c w /1: cw ~all i s ion 1 j.~! U. S. A I R F 0 R C E T E C H H I C J. L I H F 0 R M A T I 0 H S H E E T This quostionnalro has boon prepared 10 that you con .give tho U. S. Air Foree aa much lnf01mation as pouiblo concerning tho unidentified aerial phenomenon that you hove obaervod. try to answer oa many questions as you possibly can. The Information that you give will . be used for rosoorc:h purposes, and wll.l b. regarded as eonfidont lol material . Your nomo will not be used In connection with any statements, conclusions, or pub II cations without your pmlulon. We request thla personal Information ao that, If It Ia doomed nec:euory, we moy contact you for further details. 1. When did you aeo tho obfoct? 2. Timoofdoy: (Circle One): A.M. C.: (p.M.') 3. Time zone: (Circle One):@ Eastern b. Control c. Mountain d. Pacific (Ci;c/e One): o. Daylight Saving City or Town Stat or Country 5. Ea'tlmote how long you sow tho object. Houre S.conde 5.1 Circle one of the following to Indicate how certain vou are of your anawer to Question 5. b. Fairly certain 6. What woa tho condition of tho sky? (Circle One): a. Bright daylight b. Dull daylight c. Bright twilight c. Not very sure d. Just a guua d. Just Cl trace of day I ight ~No trac:e of daylight f. Don't remember 7. IF you saw the object during l)A YLIGHT, TWILIGHT, or DAWN, where was the SUN located as you looked at the object? . (Circle Ono): o. In front of you b. In back of you To your right A TIC P'ORM NO. !64 ( 13 OCT U) d. To your loft o. Overhoad f. Don't remember IF you I('IW the oufec:t, at NIGHT, TWILIGHT, or DAWN, what did you notice c:onc:ernfng the STARS and MOON? 8.1 STARS (Circle Ono): 8.2 MOON (Circle One): a. Bright moonlight b. Dull moonlight @ No moon I lght -pitch 'darlc d. Don't remomber d. Don't remember Was the object brighter than the background of the aky? (Circle One): @Yes b. No c. Don't remember IF It was BRIGHTER THAN tflo sky background, was tho brightness like that of an automobile headlight?: (Circle One)(~} A milo or more away. (a distant car)? ; <Tu..) t . l ' /' ... ~. b. Several blocks away? ~t: c. A blo~k away? d. Savored yards away? Old lhe object: a. Appear to stand still at any time? b. Suddenly speed up and rush away at any time? c. Break up Into parts or explode? d. Give off smoke? e. Change brightness? es f.' Change shape? g, Flicker, throb, or pulsate? (Circlo Onet for each question} Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know Don't Know Old the object mo.ve behind something at anytime, particularly a cloud? (Circle One): Yes ~ Don't Know. IF you answered YES, the.n tell what Did tho object move In front of something at onytlmet, particularly a cloud? (Circle One}: Yes (g;) Don't Knnw. IF you answered YES, than tell what Pid the object appear: (Circle One): a. Solid? b. Transparent? c. Don't Know, Old you observe the obioct through any of the following? Eyeglasses Yes Binoculars b. Sun glasses Yes Te losc.ope Wlndshio ld Yes Theodolite Window g Ia 5S Yes , Tell In a fi)W words the following things about tliG object, Draw o pletur" that w:ll show the shape of the oblect or o bjoch. Lobel and lndude In your sketch ony detCJ lis of tho obfoct 'hat you aaw such os wings, protrualon1, ~tc., and ospoclally cuchau't ,,alia or vapor trolls. Place an arrow bosld<J the drawing to ahow tho dlroctlon the obiect was movlno. Tho edgos; of th~ object were: (Circlo Ono): a. Fuu -y or blurred b. Ll ke o br lght star c. Sha.rply outlined d. Don't remember IF thero was MORE THAN ONE obieet, then how many were there? &?4- I ct=4/~ . _ .... -- - Draw a picture of how they were arrongod, and put on arrow to show the direetlorf that they were traveling Draw a picture thot wllt show the motion that tho object or objects macfa. Place on A at the beginning of the'path, a s at tho end of the pa.th, and ahow anv. ,ngoa In direction during tho courae. IF POSSIBLE, try to gueu or estimate what the real slzo of the object waa In Ita longest dimension. How Iorge d ld the object 9" obiech oppttar at compared with OM of tho following objoc.ts. he/a In tho hand and at ohout arm' length? (Circle One): . /a. Haad of a pin g. Sliver dollar betwet.---..b. Pea h. Baaebal't Grapefruit Basketball Quarter lc. Other f. 'Half doll or (C irele One of .the following to lnd lcate how certain you aro of yolK answer to Question 22. c. Not very sure b. Fairly certain d. Uncertain How dicl the object or obfech d isoppear from view? In order thot you can give at clear Cl picture at poa1lble of what you taw, we woulcf lllce for you to Imagine that you c.oulcl con1truct the oLfect that you aow. Of what type material would you moke It? How larg would It be, oncf .wh.at ahape would It hav? Oeacrlbe In your awn worda o ~ommon ol.fect or obfecte which when placed up In the sky would give the same appearance etl the oblect which you taw, 25. Where were you lucoted when you sow the object? (Circle One): a. Inside a building b. In a car d. In on a irplone 26. Were you (Circle One) . a . In the business sec tion of a city? @ In the residential section of o city? c. In open countryside? d. Flying near on airfield? e. Flying over ci city? f. Flying over open country? 27. What were you doing at the time you sow the object, and how did you happen. to notice it? 28. IF you were MOVING 'IN At~ AUTOMOBILE or other vehicle at the time, then complete the following questions: 28.1 What direction were you moving? (Circle One) a. North c. East b. Northeast d. Southeast f. Southwest 28.~ How fast were you moving? ----------miles per hour. 28.3 Did you stop at any time while you were looking at the object? (Circle'One) Yes No 29. What direction were you looking when you first saw tho object? (Circle One) (9Northeost d. Southeast f. Southwest 30. What direction were you looking when you lost saw the object? (Circle One) b. Northeast (f) Southeast f. Southwest h. Northwest 31. If you ore familiar witn 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_l.torth b. From horizon 4 -degrees. 31.2 When it disappeared: 5 () b. From horizon ..3 5' _degrees. C .- 34. What were the weather cond,itions at the time you sow the object? 34.1 CLOUDS (Circ:le One) ~Clear sky c. Scattered clouds d. Thick or heavy clouds e. Don't remember WEATHER (Circle One} b. Fog, mist, or fight rain c. Moderate or heavy rain e. Don't remember 34.2 WIND (Circle One) a, No wind 51 ight breeu c, Strong wind d, Don't remember 34.4 TEMPERATURE (Circle One) Don't remember 35. When did you report to some official that you had seen the object? Ooy Month Year 36. Was anyone else with you at the time you saw the object? (Circle One) ({;) No 36.1 IF you answered YES, did they see the object too? (C ire /e One) @ 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? (C ire /e One) @ No . 37.1 IF you answered NO, then when, where, and under what circumstances did you see other ones? 38. In your opinion what do you think the object was and what might have caused it? 39. Do you think you can estimate tho speecl of tho object? (Circle One) IF you answered Y~S, then what speed would you estimate? 40. Do you think you can ostim.ate how far awciy from you tho object was? (Circle One) IF you answered YES, then how far away would you say it was? 41. Please gi\le tho followi information about yourself: Firat Nome ADDRESS ~'2 Zone State Please indicate any special educational training that you have had. d. Post graduate ---------- e. e. Technical school------------- f. Other specia I training /1/e r ;fj-'~ t n '~ 42. Date you completed this questionnaire: