PROJECT 10073 REC0~1D CJt.~D 2. LOCATION 12. CONCLUSIONS Was Balloon Probably Balloon Possi \,1 y Balloon 3. DATETl.:oAE GROUfl ._ TYP! OF OISERVATIOH D Ground-VIsual 0 Was Aircraft 0 Probably Aircraft -: ,.., ':1' 'l": D AiP.Yi.ual 0 Air-Intercept Radar D Poss;bly Atrcraft 0~ Was Astronomical _ .r. 0 Ground R odor D Y C ProbaW, Astronomical 7. LEHOTH 011 OISIRYATION I. NUMI!R 011 OBJECTS 9. COURSE 0 Other _ C Insufficient Doto for Evoluotion 10. 8111111 SUMMARY 011 SIGHTING 11. COMMENTS 0 Unlc no wn' U. S. A I R f 0 R C E T E C H M I CAL I H F 0 R M A T I 0 H S H E E T This questionnaire has been prepared ao that you con give th U. S. Air Foree aa much infetmotion as possibl concerning th "nidentifiod a~rial phenomenon that you hove oJ,sctrved. Plas try to anawer aa n.any qu~ations as you possibly con. The information that you give will be \lsd for research purposes, and will be regarded aa confidential material. Your narne will not b ~ed In conn.ctioft with any statemnta, conclu1ions, Of publications without your permisaion. Wt r.,qust this p.raonol information ao that, If it Ia deemed nceasary, wa moy contact you for f~,,~r.er details. When did you e the obiact? Time of day: Coy Month Year (Circle One): 3. Tim zone: (Circle One): o. Eastern (Circle On): Day I i ght Sa ving b. Central b. Stondar~ c. Mountain d. Poci fie Neer Poetol Addret City or Town Stote or Country Adcllri onal remarks: S. Estimate how long you sow the object. Houn Mlnut 5.1 Circle one of the following to indicate how c:rtain you ar-. of your onawer to Qu.-stion 5. o. Certain c. Not very sure d. Justo guess b. Fair I y c er to in 6. w:lat w:a ih e conditicn of th~ sky? {Circ . e 0;:~): a. Bright daylight d. Jus t o trac., of da y I ight b. Dull daylight e. No trace of Jayli11ht c. Bright twiliuht f. Don't r~rnember 7. IF you saw thtt obiect during OA YLIGHT, TWILIGHT, or DAWN, whttre was the SUN loca t"Jd a s you loo!.c,d a t the obiect? (Circle Ono): a. In fr \lnt of you b. In hock of you c. To your right d. To you r left tt. Overhea d f. Don't remember A TIC fo~ORM NO. &6 4 ( 1J O C T S 4) 8. IF you saw the Clufect, at NIGHT, TWILIGHT, or DAWN, what did you notice c oncerning the9 STARS ond MOON? 8.1 STARS (Circle On-,): 8.2 MOON (Circle On,): Bright moonfloht Dull moonlight No moonlight -pitch darlc 0'Jn't remornber Don't r e member 9. Was the obj~ct brighter than the background of the sky? (Circle One}: c. Don't ' ""'"mber 10. IF it was BRIGHTER THAN the sky background, wos th., brightness like that of on automobile headlight?: (Circle One) a. A mile or more away (a distant cor)? b. Several blocks away? c. A Llock away? d. Severa I yards owoy? 11. Old I he ob j&e t: (C Ire/() On~ foJr eoc:h question) a. Appecr to stand stlfl atony time? Don't Know b. Sudde,ly sp~ed up and rus h away at any time? Yes Don't Know c. Brook up into parts or explod'? Y e s Don't Know d. Give ci( s mo'ce? Don't Know e. Cha,~e brightness? Yes No Don't Know f. Chons& shape? Don't Know g. F Iicker, throb, or pulsato? 12. Did the object move behind some thing at anytime, particularly a cloud? (Circle Or~}: Yes No Don't Know. IF you answered YES, then tell what 13. Did tha obje~t :-'l~ve in front oF something ot anytime, particularly a cloud? (C irclo 0:"1e ,.: Yes Don' t Knnw. IF you o:uwer.td YES, than tall what Did th~ ob iect o;>poor: (Circle One): o. Sol ld? b. Transpor~nt? Don't Know. Did you observet th9 objoct through any of the following? Eyt~glos:aes e. Binoculars Sun glo !i ses Teloscop.! Ye!l Vlindshittld No g. Th~odol it" WindQw gfcsc; 17. Dr:JW ,, pict .. rf! ~: ~t wf:l show ~h~ 'l:,opc of th~ obl~ct ()r o';.jJCh. loh8! '=',1d fnclud' Ill ynJI ~ka~c:h "",., J~tt~ll-. IJI! thJ ocl ,-; ;r::? ~ ~\1 GOW r;vch 0 ~ win~.,, ~ro~ruaio.u, .'ltC., C!"'J 0:\puc:rJIIy ~xhou3t ttCJII~ ~, vopor fr'llb. Pht.J r.~n ~tro,., be' :o8 ~-d:C'-ning to t;{,..:,, th~ d irl)tflon fh !Jbj~cf wal rnovinu. b. Llk"aLrightst"lr c. Sh.::rp!y outlin~d d. Don't r ),n{,mb~r 19. IF thetro .v:z s .')ORE THAN ONE obj e :t, then h" w m(1ny were thor'!? - pi<:tun :1F hllw th&y w~uo ua o ~.;')d, c:~cl !>\It on aucw , ,., .1h0'r., the l irjt:~ion t1tot fh~y wn.., ,,av31ing. 25. Where were you lucatt!d when you ~uw tht'~ object? (Circle One): a. Ins ide a building d. In on airplane 26. Wuro you (Circle One) In the bus in~ss section of a city? In the residential section of a city? c. In open countryside? d. Flying near an airfield? e. Flying over a city? 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 AN AUTOMOBILE or other vehicle at the time, then complete th" following queJtions: 28.1 What direction were you moving? (Circle Q,,e) a. North c. East e. South r,. West b. Northeast d. Southeast f. Southwest h. Northwest 28.2 How fast were you moving? 28.3 Did you stop at any time while you were looking at the obiect? (Circle One) Yes No 29. What d irection were you lookin g wh,n you first saw the obiect? (Circle One) e. South g. b. Northeast d. Southeast f. Southwest h. What d irection were you lookhg whe n you lost saw thct obiect? (Circle One) South West North c. East b. rtneost d. Southeast h. Northwest 31. If you cr~ ~;-n' !ior with bearing terms (o ngular direction), try to estimate the number of degrees the object wos from t.-..~e '~-rtJ, and also tho nu.-nbe r of d~grees it was upward fr om the horizon (olavotion). 31.1 Wh~n it firstoppoarcd: o. From true No;th ---- degrees. b. From horizon "~:.:' _-_:_ dogrces. 31.2 When it d i sappoored: o. From tru~ tlorth b. From hor i.e on -------r!cgrces. degrees. 34. What wero the weather conditions at the time you sow the obiect? 34.1 CLOUDS (Circle One) 34.2 WIND (Circle One) Clear .sky a. No wind Slight breeze c. Scattered clouds c. Strong wind Thick or heavy clouds Don't remember e. Don't remember WEATHER (Circle One) 34.4 TEMPERATURE (Circle One) Fog, mist, or light rain c. ,V,oderate or heavy rain e. Don't remember Don't remember 35. When did ; ou report to some official that you had seen the obiect? 36. Was anyone else with you at the time you saw the object? (Circle One) Yes No 36.1 IF you answered YES, did they soe the obiect too? (Circle One} Yes No 36.2 P I.!~Se I ist their names or.d addresses: 37. Was this the first time that you had seen an object or obiects like this? (Circle One} 38. In your o~ nion what do you think the obiect was and what might hove caused it? 39. Do you think you can estimate the speecl of the obiec:t? 'Circle One} IF you answered YES, then what speed would you estimate? 40. Do you think you c:an estimate how far away from you the obiec:t was? (Circle One) Yes No IF you answered YES, then how far away would you say it was? 41. Please tion about yourself: City Zone State TELEPHONE NUMBER Please indicate any special e ducational training that you have had. a. Grode school Technical school b. High school Other special training Post graduate 42. Date you completed this questionnaire: (SUI.lMARY DATA) In orde:-that ~our information rnoy be filed and codad os occurntoly a s possible , please use the following !.pace to Ytrite out a :thort description of the event that you obsc rvad. iC'u mfly re peat ir.formation that you have already given in the questionnaire, and odd \.lny further ct~mi'T'W!nts, stot!ments, or skotches that you believe ore important. Try to FJresert the d etails o f th~ ob=>erva tier. in the order in which they occurred. Additional pages of the same sixe p~,?ctr moy b~ attached if th~!y are needed. (Go Not W,ite ;,, T hi s Space) (PI cos~ Print)