a w Boll" l-3. DATITIMI 4. Ill OIIIRYATIOM D PoaaiWr Bollooft 11 R... D Woa Alrcroft swt --...vw.Uft I au ' "" Pre~ltlr Alrcreft ======--'--a AI .. VIol a A R... a PoaaiWr Alraoft D Woa Aatronol col a Yea D ProltoWy AatrenoMicol . )II No Civilian a PoaaiWr Aatroftoeseloel 7. LINOTH OP IVATION L NU,.II OP OIJICTI t. COUIII D Othor~-~----!- - 10. IIIIP Ofl Bright shiey spot like lisht, appeared vapor-like. 2 obJts approach- iDS fm SSW passed obJts and went out ot sight Returaed fm NE and approached objt again. Bright shiQy spots about size of a/c. Tremen- dous speeds. AftC POM 121 (JtaY It ... II) 0 lnaufflclont D '-Evoluotlon I 1. COMMINTIThere is no evidence available which would indicate that obJts of sight ing were anythiDg other than high flying a/c reflecting stmlight. , U.S. _,_,R fORCI TECHNICAL .IHPORMATIOM SHEIT thl onnalre ha prepareclo that you can give the U.S. Air Force as much Wormatlon .as poasible concerning the unidentified .aerial phenomenon that you have observed. try to as many qu.stion1.as.you poaalbly.can. The lnforntatlon thot.you glvewlll lie uaecl for res.-ch purpose1,.ancl will be regarclecl.as confidential material ... yOVt nocne wlllnoi I. useclln connection with any s, .conclualona, or publlcatlona. without yoyr .pm.laalon. .. request .thla per1onal I ion ao that, If It 1a neceaaory, we con~ct you f~ fwther cletalla. 1. When did you the obiect? :2. Tinea of~day: 3. Time Zone: r (Circle One): ~.:)Eastern li. Central c. Mountain d. Pacific 4. Where were you when the obfect? S. How long was obiectin sight? 5.1 How was tinse in sight determined? a. c.rtain b. Fairly certain . 6. What was the condition of.the=sky? .(Circle One): (Circle One): Daylight Saving . ~Standard Not very sure Just a guess 7. IF you saw the obiect during DAYLIGHT, where was the SUN located as you looked at the obiect? (Ci,.cle One): a. In front of you In back of you ( ~ To your, r;ght /"1 .c i d. To your left e. Overhead f. Don t remf!mber /:, 164: Thi fotm aupersedes A TIC 164, 13 Oct 54. 8. IF you aaw.the ol,iect.at NIGHT, what did you notice.concarnlng.the STARS.and MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle One): a. Bright moor.llght b. Dull.moonllght cL Don!t re11:amber c. No n.oonllght-pitch clarlc :9. The olaiect. :(Circle.One): 10. If .It appeared as a light, was It lwlghter tha~ the brightest :stars? cl. Don't ,...._mber a. Appear.to stand still at any time? b. Suddenly speed.up and ruah.away at any thne? e. Brealc up into parts or explode? .cl. Give off smolce? e. Change brightness? f. 'Change shape? g. F I ash or fli clcer? h. D i a appear. and reappear ? 12. Did the ol,ieet.mwe Nhlncl Sotliethlng.atany time, particularly a cloud? Don't Know Don't Know Don't Know .Don~t Know Don't KnOW' -Don~t Know Don~t Know Don~t Know (Ci'rc/e One): . Yes No /Don't K~. .IF you.answerecl YES,.then tell what. 13. Did the ol,iect .move In front of s01nethlng at any time, partic~larly .a . cloud? . (Cir~le One): . Yes @ Don't Know. . IF you answered YES, then tell what .b. Transp~re~t ~c:; V~por 14. Did the ob;eet.appear: . (Circltt One): 15. Did you observe the obieet through any of the following? .a. Eyeglasses b. Sun glasses c. Windshi~ld .d. Window glass e. Binoculars f. Telescope g. Theodolite d. Don~t Know 16. Tell in a r.w worcla the foil thing aiMM the oltlect. 17. Draw a picture that will .the.ahapeof .the obiec:t.or.ol.iecta. La~l:ancl lne,ucle:ln your;alcetch.any details of the :that ~.eaw 'luch ae wlft11 protrualone,.etc.,::ancl eapeclally .exhauat tralle.or trail e. Place an.MOW.-.Icle.the ng.~ahow.the dlrectlon:the ol.iect:waa. 18. The edges of:the oi.Ject.were: (Circle Otte}: a. Fuzzy or .blurred . .b. L11ce.a bright star e. Sharply outlined . Q;} Don ~t remenw here wae MORETHAN ONE obiect~ then how many were there? J-tA ... 4 fHN. lJ .... ~"ii1.-: .5" .... a picture of how they.were arranged, .and put an arrow.to how.the cllrectlon.that.they.were traV.IIng 20. o picture will ahow the thotthe oltiect or oblecta.macle. P.lace.an''A" at .the beglnnlnt of th. path, o "8" ot the encl of the path, oncl :ahow.any .changes In direction during the course. cllcl:the altiect: . to you.oa 22. Wewlah to .theangular:alze. Hold:a match.atlclc .. ot 1 length In line. with a lcftown. . how.much of.the ollect:laccwerecl by. the of.the If y~ hacl this uper of the sighting, .how "'uch of the obtec:.t would have been coverecl.by the match head? 23. Did the oblect.dlaappear:while you w.re watching it? If so, how? .Oncl.note :ot the time In order that you can giV. as cl :a picture as pOssible of.what you:saw,.descrlbe.ln your own.worda.a common obtec:t or obiects.whlch, when placed.up In the sky, would give the some .aa the obiect which you.aaw. 1 Where were you located when you aaw the oliec:t? (Circle One): a. lnalcle a IM.IIcling b. In a c c . Outcloora 26. Were you (Circle One) a. In the bualne11. I on of.a city? b. In the realclentll sec:tJon of.a city? ~ In open.countryslde? d. Near an airfield? . e . Flying over a city? f. Fly.lng over open .. country? ~7. What were You clol.ttg. at the tl you aciw the oblect, .and how clld you happen to notlcelt? IF: you were MOVING IN AN AUTOMOBILE C:W other.vehicle at the time, then coe1rplete.the following questions: 28.1 . Wh~ di,..ction were you moving? (Ciiele One) b. Northeast . d. Southeast f. Southwest 28.2 How fast were you moving? ~ ~-miles per hour. 28.~ Oid you-stop at any time whi.le y e loo~ing at the obiect? (Circle One) Yes No 30. What direetion were you l~klng when you .last saw 'he obiect? (Circle One) a. North b. Northeast d. Southeast f. Southwest h . Northwest @ North~est I I. Overhead 31. If you are familiar with bearing terms (angulardirection), try to estimate the number of degrees.the obfect.wos from true North (thr.u east) and also the number of degrees it was upward from the horizon (elevation). 31.1 When it first appeared: a . From true North degrees. b. From horizon degrees. 31.2 When it disappeared: a. From true North degrees. b. From hori~on degree 34. What were the conditions .at the time you saw the obiec:tt CLOUDS(Circle One} @ Clemr alcy cl. Thiele or heavy clouds WEATHER (Circle One} Fog, mist, or light rain c. Moderate ar : 35. When oncl to whom dicl you repcwl that. you hacl seen the Hiect? 6~ aY~j ut ., Month Veer 36. Was anyone else with y~ at the time you saw the obJect? (Circle One} 36.1 IF you answered YES, did they ... the obiec:t. too? (Circle One) 36.2. Please list their nan and 37. Was this the first tinoe that you hod seen.a.n obiect or obiects like this? (Circle One) 37.1 IF you answered NO, then when, where, and under what circumstances did you s" oth.r ones? 38. In your opinion what do you thinlc the obiect was and what might have caused it? 39. Do you thlnlc you can (Circle Orte} IF you on .CO. Do you thlnlc you con estl how far you the object. wos? (CI~Ie.One) ~ IF you onswerecl YES, then how for .. 1. Please give the fol TELEPHONE NUMBE .a~. youtH If: lndicqte any.ocldltlonal information:about yourHif, Including any edueatlon,.whieh.mlght:be 42. Date you.eompleted this.questionnair~: U.S. AIR PORCI TICHMICAL INFORMATION IHIIT (SUMMARY DATA) . In cl that your iiiay be flied and coded aa accurately as poaalble, pleaae:uie to write out a.ahort deacrlptlon of the event that you obaerwcl. You IINIY res that you hcwe already given In the queatlonnaire, and aclcl any further. or alcetchea that you lelleve are Important. Try to preaent the details of the tlon In the order In which they occurred. Additional pages of the sanae size paper. n10y 1. (PI Prhtt). (Do Hot Write In Tltls Spoce)