1. DATI TIME GIOU' 4. NUMIIA 0, OIJICn S. LINOTH 0, 16 S e corrls 9. PHYSICAL EVIDINCI 2. LOCATION 10. CONCLUSION 11. IIIIP IUMMAitY AND ANALYIII Object fl3.shed a s i t d isappeared b ehind trees. Hazy ni~ t, .:.t_:'!)eared. a s brig~1t as :w adli_:;ht. Sil ver c olor. Green ~.:l.lo J..round objact. Estii:-e.t(~d to b~ e:~t.re.:kly large i n size. _nou~ lll ;AJ oe auou~.~ J::J.. c::; };ra;/. .. eva,Jl.on re [.)Crt ')Q C::.3 L:-5 de._1rees 45 .le ;_-;r e s ) and yet ob j :Jct rl.:..:.>~(_;pz.::rod b 3:lind trees. 1 0 :oco:~l-i.: U.S. AIR FORCE TICHNICAL IMFOIMATIOM This questionnaire has been prepared so that you can give the U.S. Air Force as much information as possibt. conceming the unidentified aerial phenomenon that you have observed. try to answer as many questions as you possibly can. The I on that you give will for purposes, Your no,.. will t be used in connection with any s s, concluslena, or pultiJcatlona without your permission. We requt this personal I ion so that If It Is cleelllecl necesaary, w contact you for further details, . . .. 1. When did you '" the object? ~. Time Zone: . (C lrcle One): Central c. Mountain d. Pacific 4. Where were you when Y-' saw the obiect? (Circle One): (Circle One): Daylight Saving Standard City w State w Covnty J, Htw IOftt wet ol.iect in sight? (T Our .. len) c, Not very aure How was ti 5.2 Woa oltiect in aight continuously? 6. Whet wen the concUtion of the slcy? 7. IF you IGW the oo;ect during DAYLIGHT, where WCII the SUN located 01 you look.d at the obiect? (Circl One): .:1. !n front of you Ia b.ck of you e. To yout ridtt d. To 'j04Jr !eft ~. Overhead f. Don't rmmO.r FTD OCT '2 164 Tlaie I ... P PTD IH, JW 61, wtUata ie obeolete. 8. IF you saw the obiect at NIGHT, what did you notice concerni11g the STARS and MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle One): a. Bril)ht moontight DtJll mQonl ight d. Don't renuemiler No tnoonl iQht -pitch dark 9. Whot were the weather conditions at the thtie you saw the obiect? CLOUDS (Circle One): Clear alcy c. Scattered clouds d. Thiele or h.avy clouds 10. The obiect appeared: (Circle One): b. Transparent WEATHER (Circle One): og, mist, or light rain c. Moderate or heavy rain e. Don't remember as a light, was it brighter than the brightest stars? (Circle One): c. About the same d. Don't lcnow The edgea of the object were: (Circle 0,.): a. Fuzzy 01 blurred e. b. Like a bright star Sharply outlined d. Don t remember lJ. Did tne obict: a. Appear to stand still at any time? b. Suddenly speed up and ru.sh away at any tim? c. Break up into part.s or oxplod? d. Give uff smoke? Change brightness? f~ Chanf)e .\hape? g. F la1i1 or fl idcet? h. Oiappear \lnd reappear? Don't know D<>n't know Dan ' t kno w O<.:;n't know Don't know O.n' 1 ''ntlW l,;p t ,trO'tll Don' t know 14. Did the obiect disappear while you were watching it? 15. Did the obiect move behind something at any time, (Circle One}: If so, how? icularly a cloud? IF you answered YES, then tell what 16. Did the obiect (Circle One): in front of something at any tin:e, particularly a cloud? 0 Don't Know. IF you answered YES, then tell what 17 . Tell in a few words the following th lngs about the obiect: 18. We wish to len ow the OfttUiar size. Holcl a match sticlc at arm's length in line with a known obiect and note how the obiect is covered by the head of the match. If you had perforn:ed this experiment at the time of the sighting, how much of the object would hGYe been covered by the match head? 19. Draw a picture that will show the shape of the ob;ect or obiects. Label and include in your sketch any details of the obiect that you saw such as wings, protrusions, etc., and especiatly exhaust trails or v'apor trails Place an c.row beside the drawing to show the direction the obiect was moving ~. Do you th inlc you can estimate the spHd of the obiect? (Circle One) you answered YES, then what speed would you estimate? ------ 21. Do you thinlc you can e (Circle Otte) away from you the obiect was? f away woulcl you say it was? _j/~2..~....-1- t~-((~ IF you anawered YES, then 22. Where were you located when you saw the obiect? (C ire/ One): a. Inside a builclint @In a car c. Outdoors cl. In an airplane (type) 23. Were you (Circle One) a. In the t.usiness section of a city? @ In the residential section of a city? In open countryside? d. Near an airfield? e. Flying over a city? f. Flying over open country? 2 .. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the ti , then complete the following questions: , 24.1 What direction were you moving? (Circle One) b. Northeast d. Southeaat f. Southwest h. Northwest 24.2 How fast were you moving? miles per hour. 24.3 Did you atop at any titne wh i ie you w.,e loolcing ot the obiect? (Circle Q,.J 014 you obaerve the olt;.ct through any of the following? Eyeglaasea Binoculars b. Sun glasses Winclehielcl Theoclo I i te Yes No Window glass Yes In order that you can give as clear a picture as possible of what you sow, describe in your own words a common obiect or obiacts which, when placed up in the slcy, would give the appearance as the object which you saw 27. In the following slcetch, imagine that you are at the point shown. Place an "A" on the curved line to show how high the obiect was above the horizon (slcyline) when you lirst saw it. Place a "B" on the same curved line to show how high the obiect was above the horizon (slcyline) when you last saw it. Place an " A" on the compass when you first saw it. Place a "B" on the compass where you last saw the obiect. 28. Draw a picture that will show the motion that the obiect or obiitcts made. Place an "A" at the beginning of the path, a "B" at the end of the path, and show any changes in direction during the course. 29. IF there was MORE THAN ONE obiect, then how many were there? ::_ ..... ~--=--- Draw a picture of how they were arranged, and put an ,.row to show the direction that they were traveling 31. Was anyone else with you at the time you saw the obiect? (Circle One) 31.1 IF you answered YES, cUcl they '"the obiect too? (Circle One) 31.2 Plea .. list their names aM 32. Please give the followi,. I"'' ion about yourself: TELEPHONE NUMBER AGE _J.._Cj~ Middle HeMe Zone State IMicote any additional informotiOf' about yourself, inci&Hting any special experience, which might be pertinent.