PROJECT 10073 RECORD CARD 2. L OCATION 12. CONCLUSIONS Wo~ Balloon lloraine, Ohi:> 0 P robably Balloon 3. DATE-TIME CROUP TYPE OF OBSERVATION Possii>ly Balloon ;.l:( Ground-Vi suol 0 Ground-Radar 0 Was Aircroh a:: :probably Aircraft 0 A i,..Visuol 0 A ir-Intercept Radar 0 Possibly Aircraft s. PHOT OS 6- Was Astronomi col P robobl y A stronomi col 0 Possibly Astronomical 7. LENGTH 01" OBSERVATION NUMBER OF OBJ ECTS 0 Insufficient Data for Evalu ation BRIEF SUMMARY 01" SIGHTING Ol'>j de:;cribcd tll> l'l"Jbo b 1 y j0\:. 1r/aftcrburne r ATZC PO._W l,. ()t.V 2 SJtP 52) U. S. A I R F 0 R C E T E C H N I C A l I N F 0 R M A T I 0 H S H E E T This questionnaire has been prepared ao that you can give the U. S. Air Force as much Information as possible concerning the unidentified aerial phenome non that you have oburv~d. Pl,ou try to answer oa many questions as you possibly can. The information that you give will be used for research purposes, und will be regarded oa confidential material . Your name will not be used In connection with any statements, conc:lusions, Of publications without your permiuion. We request this porsonol information so that, If It Ia deemed neceasary, we may contact you for 1. When d id you see the object? Doy Month Year 3. Time zone: (Circle Ond): a. Eas tern b. C o ntro l d . Poci fie 4. Where were you whn you sow the object? 2. Time of day: (Circle One): (Circle Ono): a. -~ovlng ~ ?tandard , City or Town Stote o r Country Adcllti anal remarks: S. Estimate how long you sow the object. Hourt Minute Second 5. 1 Circle one of the following to indicate how certain you ore of your answer to Question 5. (Q! Certo in -' b. Fairly certain 6. What woa the c onditicn o f tho sky? (Circle One): a. Bright daylight b. Dull daylight c . Br igh t r . .,ilight c. Not very sure d. Just a guess d. Jus t a trace of day I ight <8:-tfo_-:-tr. -of day_l_igfi.D L Don't remernbtH 7. IF you sow tha object during DAYLIGHT, TWILIGHT, or DAWN, whore was tha SUN located as you looked at the object? (Circle One): a . In front of you b. In bock of you c. ToroJrright ATIC FORM NO. 164 ( 13 OCT ~4) d. To your left a . Overhead f. Don't ;cmemb~H 39. Do you think you con estimate the speed o f the object? 1 Circle One) Yes No IF you answered YES, the n what speed would y o u es tima te ? 40. Do you th ink you con e s t imate how for away from you t he object was ? ( Circle One) Yes No IF you answered YES, then how fa r away would you soy it was? 41. Please give the following information about yourself: 5 E. E. 21,//'?1'1/ri?.. Y D.ff//r si,i-.~2_ Middle Nome C ity Zon e T ELf::PHONE NUMBER Pleas e indico te any spe illl t:ducat ionol tr aining that y o u have hod. b. High s c h oo l T echnicol school f. Other sp~ciol training------------- 42. Dote you completed this q uestionna ire : 8. IF you saw the ouject, at NIGHT, TWILIGHT, or DAWN, what d id you not ice concerning the STARS and MOON? 8.1 STARS (Circle O ne): 8.2 MOON (Circle One): a. Bright moonlight b. Dull moonlight c. No moJ)nlight -pitch doric r!~ Don't remember_......;- ( d..._R.qr't remomber .:. 9. Was the object brighter than the bac kground of the sky? (Circle One): b. No c , Don't reme mber 10. IF It was BRIGHTER THAN the s ky background, was the brightness l ike t hat of on automobile headlight ?: (Circle One) a. A mile or more away (a distant car}? b. Several blocks away? c. A block away? d. Severa l yards away? 11. Old lhe object: o. Appea r t o stand still atony ti m.,? L. Suddenly speed up and rtnh owoy at any time? c . Break up into ports or explode? d . Give off smoke? o. Change brightness? f.' Change shape? g. F Iicker, t hrob, or pulsate? (Circle One for oach quution) Don't Know Yes No Don't Know Yes No Don't Know Yos No Don't Know Yes No Don't Know Don't Know Yo1 No Don't Know 12. D id the object move behind something a t anytime, particularly a cloud? (Circle One): Yes No Don't Know. IF you answered YES, t hen tell what 13. Did the object move In front of something a t anytime, particularly a cloud? (Circle One): Yes No Don't Knnw. IF you answered YES, than te ll what 14. Did tn., object appear: (C ire/., One ): o . Solid? Did you observ e the object through ony of the following? a. Eyeglasses No o. Binoculars Sun glosses Yes Tolescope Yes Windshield Yos T heodolite Yes No /indow r,bs:; U. S. A I R F 0 R C E T E C H HI CAL I H F 0 R MAl" I 0 t1 S H E E T (SUMMARY DATA) In or.der that your in!ormation may be filed and coded as occurntoly as possible, please use- the f~llow.lng.:.pace to vmte out a short description of the event that you obsaved. Yc-u may re peat 1r.formot1on that you have already given in the questionnaire, and add .:~ny further c<-mments, statements,~ sketches that you believe ore important. Try to J:>resert t he details of the observa- tion in the order in which they occurred. Additional pages of the some size p~per may b., attached if they ore needed. (Go Not W.ite ;,, Thi s Space) h,t.SJ-P /rT OL;-//,. l?r~r: ./ vs/Jr: