U.S. AIR FORCE TECHNICAL .INFORMATION SHEET This questionnaire has been prepared so that you con give the U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you hove observed. Please try to answer as many questions as you possibly can. The information that. you give will be used for research purposes, and will be regarded as confidential material. Your name w ill not be usedin connection with any statements, conclusions, or p'ublications without yo"!r permission. We request this personal information so that, if it 1s deemed necessary, we may contact you for further details. When did yol) aee the object? 2. Time of day: (Circle One): 3. Time Zone: ;- , (Circle One)~. ~astern c. Mountain d. Pacific ( Circle One~-: D~l!!.aht _Sa,yJnQ...g - 5. How long was object in sight? 5.1 How was time in sight determined? a. Certain b. Fairly certain 6. What was the condition of the sky? c. Not very sure d. Just a guess "-_a. Bright 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object? {Circle One): a. In front of you b. In bock of you d. To your left e. Overhead c. To your right f. Don't remember AT I C :e Ef~o 164 This fotm supersedes A TIC 164, 13 Oct ~4. 8. IF you saw the object.at NIGHT, what did you notice concerning rne STARS and MOON? a. 1 STARS (Circle One): MOON (Circle One): Bright moonlight Dull moonlight No moon I ight -pitch dark ~-Don't remember Don't remember 9. The object appeared: 4 As a light (Circle One): Don't rem~mber 10. If it appeared as a light, was it brighter than the brightest:st~rs? Did the object: (Circle One for each question) Appear to stand still at any time? Don't Know speed up and rush away at any time? Don't Know c. Break up into parts or explode? Don't Know d Give off smoke? Don~t Know Change brightness? Don't Know f. Change shape? Don't Know Flash or flicker? Don't Know h. Disappear and reappear? Don't Know 12. Did the object move behind something at any time, particularly a cloud? (Circle One): Yes \.. ~ Don't Know. IF you answered YES, then tell what 13. Did the object:move in front of something at any time, particularly a cloud? (Circle One): Yes r No Don't Know. IF you answered YES, then tell what In front of: ~-- c; So~- b. Transparent c. Vapor d. Don't Know 14. Did the object appear: (Circle One): Did you observe the object through any of the following? Eyeglasses Yes ' ._No. Binoculars Sun glasses Telescope Windshield Theodolite 16. Tell in a few words the following th ings about the object 17. Draw a picture that will show the shape of the object or objects. lobel.and include in your sketch any details of the object.that you.saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place an arrow beside the drawing to show the direction the object was. moving. The edges of the object were: (Cirele One): a. Fuuy or blurred b:- L ike a bright star - c. Sharply outlined d. Don't remember 19. IF there was MORE THAN ONE object, then how many were there? {..::..J.' ...:..f ..J-;-~--------- Draw a picture of how they were arranged, and put an arrow to -show th direction that they were traveling 20. Draw a picture that will show the mot ion that the object or objects mode. Place on '"A" at .the beginning of the path, o '"B" at the end of the path, and show any changes in direction during the course. How l~e did the ieict a..-T' to ~ou a1 ~ompored_ to an obj~t wl_t which you are familiar? We wish to know th~fangular s.ize. Hold a match stick at arm's length in line with a known object.and note how much of the object is covered by the head of the match. If you had performed this experiment .at the time of the sighting, how much of the object would have been covered by the match head? 23. Did the object d isappear while you were watching it? If so, how? 24. In order that you can g ive oa clear a picture a1 possible of what you saw, describe in your own words a object or objects which, when placed up in the sky, would give the some appearance as the object which you saw. 1 1 / (, 25. Where were you located when you saw the object? (Circle One): 26. Were you (Circle One) a. In the business section-of...o-cityJ a. Inside a building b In a car--- b. rn the residential section of a city? ct-111 open countrysTcfe?---- - ...C. ..Outdoors d. In an airplane (type) d. Near an airfield? e. Flying over a city? f. Flying over open country? 27. What were you doing at the time )IOU saw the object,.and how did you happen to notice it? 28. If: you w~e MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete.the following questions: What direction were you moving? (Circle One) a. North c. East d. Southeast f. Southwest h. Northwest 28.2 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) 29. What direction were you looking when you first saw the object? (Circ:le One) -... orthwes.t b. Northeast d. Southeast f. Southwest i. Overhead 30. What direction were you looking when you last saw the object? (Circle One) a. North c. East e. South h. Northwest b. Northeast d. Southeast f. Southwest i. Overhead 31. If you ore familiar with bearing terms (angular direction), try to estimate the number of degrees the object was from true North (thru east) and also the number of degrees it was upward from the horizon (elevation). 31. 1 When it first appeared: a. From true North b. From horizon When it disappeared: From true North b From horizon 34. What were the weather ~onditions at the time you sow the object? CLOUDS ( Circle One) WEATHE R (Circle One) (~ Clear sky c. Scattered clouds d. Thick or heavy clouds b. Fog, mist, or light rain c;, Moderate or heavy rain e. Don't remember When and .. to whom did you report th'at_yov had se~!)Ah object? Doy Month Year 36. Was anyone else with you at the time you sow the object? (Circle One) Yes ( "No 36.1 IF you answered YES, did they see the object too? (Circle One) 36.2 Please list their names and addresses: 37. Was this the first t ime that you had seen an object or objects like this? (Circle One) 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 con estimate the speed of the object? ( C ircle One) IF you answered YES, then what speed would you est imate? - , . ., w~ ...... , ~, ' (-.. --..1 40. Do you think you can estimate h~w for away from you the object was? (Cir<lo Ono) 6 No IF you an~wered YES, then how far away would you say It was? 41. Please give the TELEPHONE NUMB Indicate any additional j nformotion about yourself, including any education, which might be pertinent 42. Dote you completed this questionnaire: U.S. AIR FORCE TECHNICAL INFORMATION SHEET (SUMMARY DATA) In order that your information may be filed and coded as accurately as possible, please use the following space to write out a .short description of the event that you observed. You may re peat information that you have already given in the questionnaire, and add any f~rther comments, statements, or sketches that you believe are important. Try to present the details of the observa- tion in the order in which they occurred. Additional pages of the same size paper rr.ay be attached If they are needed. {Plene Print) (Do Not Write in This Space) Case No . 1 -Although the object n:ay have been an aircraft, we feel trA t because of e unreliability of the observer the report should be rejected from s e rious consideration