1. DATI TIME GROUII 2. LOCATION ' NUMIER 0' OIJICn Che, l'TO S. LINGTH 011 0 IYATION 1 hr 10 minutes s ti1 J vi c:ti h1.e 8-mund-Visual ' Rx Centervill e , Oh~o 10. CONCLUSION 11. II II' IUMMARY AND ANALYIII Object '\d th erratic movements t hought to b e .:;as aou s vapors, as bright as an arc 1 i ght, F.rratic novez:1ent s, cha:1ges on brightness, fl~shin6 and fli ckerL1g, disappeari~g and reappa~r ing, trh ite azid yellovT ut edges. : !oved behind :. r ees. O':Jserve~ f1't>m :ovi:1g car. Object initially lovr on horizon in ".ast. Climbed :.0 es:.i!':'lated 4; d e g elevation. Second obj9ct appea.n : ~ bot to.!! ::nO. c. larcer object ap!=ear ed ~o o e f o r x i !1g on :~orth ::;; fJe. .:..ts VcHl U!3. V:!.:2:trs i n Zast risil~J. -.:-~in obj oct reported evalu?.tec :~s:3ociated ob ~ct:> .:.;~tJ.--.Lbut~d co i .. ~='-Siil:~:~ion of Lh~ .-2_i ::;tortion~ cit:.J L~ ~t :o::;pheric conditions. 9. PHYSICAL EYIDINCI U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force as much information as possib .. concerning the unidentified aerial phenomenon that you hove observed. Please try to answer as many questions as you possibly con. The information that you give will be used for research purposes. Your nome wi II DOt be used in connection with any staten:ents, conclusions, or publications without your permission. We requst this personal information so that if it is deemed necessary, we may contact you for further details. 1. When did you s" the object? Month Year 3. Time Zone: (C irde One): a. Eastern) b. Central c. Mountain d. Pacific Hour Minutes ' (Circle One): (Circle One): a. Daylight Saving b. Standard 4. Where were saw the object? S. How long was object in sight? (Total Ourcrt;on) 5.1 How was ti 5.2 Was obiect in igl-it continuously? What was the condition of the slcy? Ciry or Town a. Bright State or County 7. IF you saw the obiect during DAYLIGHT, where was the SUN located as you looked at the obiect? (Circle One): o. In front of you lt. In back of you c. T a your right d, Tv your lft Qv .. rheaa f. Don't remem.,_r FTD OCT 62 164 Thla f upnde PTD 164, Jul 61, wtuch t obeolete. 8. IF you saw the obiect at NIGHT, what did you notice concerning the STARS and MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle One): a. None a. Bright.m~l ight b. 'Dull moonlight-. c: "N"o ... mooniigt,i-:-pitch dark d. Don t retnemi.r d. Don't remember 9. Whot .,.,. the conditions at the time you saw the obiect? CLOUDS (Circle One): WEATHER (Circle One): C~I.~r sky~ b. Fog, mist, or I ight rain c. Scattered clouds c. Moderate or heavy rain Th iclc or heavy clouds e. Don't remember 10. The ob;ect app1ared: (Circle One): d. As a light b. Transparent .. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): ~-a. Bri~t.r ) c. About the b. Oimilier d. Don't know 11.1 ContpGN bri ~tJSe ss to scwue 12. The edges ot the obiect ware: (Circle One}; a. Fuzzy or blurred ' "-b:-LiiCe ci lwiiftt star c. Sharply out I inecl d. Don't reme111ber (Circ:le 0" for ~ach question) a. Appear to stand still at any tin:e? b. Suddenly speed up and rush away at any time? c. Break up into parts or explode? d. Give off smoke? e. Change brightness? f. Change shape? I Flash or fl iclcer? h. Di1appear and reappear? Don't know Don't know Don't know Don't know Don't know Don't know Don't know Don't know 14. Did the obiect disappear while you were watching it?. If so, how? beh incl something at any tin:e, particularly a cloucl? 15. Did the obiect (Circle One): 1 Yes 't No " Dan.'t Know. ,, IF you answered YES, then tell what 16. Did the obiect (Circle One): in front of something at any ti , particularly a cloud? IF you answered YES, then tell what Don't Know. 17 . Tell in a few words the following things about the obiect: We wi.sh to lcnow the angular size. Hold a match sticlc at arm's length in line with a known obiect ancl note how much of the oitiect is covered by the head of the nKJtch. If you had performed this experiment at the tirne of the how much of the obiect would have been covered by the match head? ,.-. 19. a picture wHI show the shape of the obiect 01 e>iects. Label ancl include in your sketch any details of the obtect lhot you saw such as wings, protrusions, etc., and especiatly exhaust trails or vapor trails. Place an arrow beside the drawing to show the direction the obiect was moving. 20. Do you thinlc you can estimate the speed of the obiect? (Circle One) IF you answered YES, then what speed would you estimate? ------- 21. Do you thinlc you can estimate how far away from you the obiect was? (Circle One) IF you answered YES, then how far away would you say it was? _._ 22. Where were you located when you saw the abiect? (Circle One): 23. Were you (Circle One) a. In the business section of a city? a. Inside a building b. In a car c : Outdoors- d. In an airplane (type) b. In the residential section of a city? (-c. In open country~ide? d. Neor an airfield? e. Flying over a city? f. Flying over open country? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then 24.1 What direction were you lltOVing? (Circle One) ~ ...... c. East South d. Southeast f. Southwest How fast we,. you ing? miles per hour. 24.3 Did you sto, at any ti"' while you we,. loolcing at the cojec:t? (Circle One) Did you oitserve the oeiect through any of the following? EyeglasMs Yes Binoculars b. Sun glasses Yes f. Telescope Windshield r No g. Theodolite Window glass the following questions: t g. West ' h. - Northwest .26. In order that you con give as clear a picture as possible of what you saw, describe in your own words o common object or obiects which, when placed up in the sky, would give the same appearance as the object which you saw . In the following sketch, hnagine that you are ot the point shown. Place an ,. A" on the curved I ine to show how high the obiect was above the horizon (skyline) when you lirst saw it. Place a "B .. on the same curved line to show how high the obiect was above the horizon (skyline) when you last saw it. Place an "A" on the compass when you lirst saw it. Place a "8" on the compass where you last saw the obiect. Oraw a picture that will show the niOtion that the obiect or obfects made. Place an "A" at the beginning of the path, a "8., at the encl of the path, and show a~ changes in direction during the .course. IF there was MORE THAN ONE obiect, then how mony .. ,. lhere? ----------- Draw a picture of how they were arranged, ancl put an arrow to show the direction that they were traveling. 34. Date you completed this questionnaire: lnfCMenation which you f .. l pertinent ancl which is not adequately covered in the specific points of the questionnaire or a narrative explanation of your sighting. 30. Have you ever seen this, or a similar obiect before. If so give date or dates and location Was anyone else with you at the tf you saw the object? (Cirde One) ~ Yes .J No 31.1 IF you ana-red YES, did they ... the object too? (Circle One} ( S N~ . ,.. . _ Plea .. list their and aclchsses: r; :!J ?~4 '("; 32. Please give the following lnforntation about yourself: Firat Name Middle.._,... IMicate any additional infouttution about yourself, including any special experience, which might be pertinent. 33. When and to whom did you report that you hod seen the object?