O.l TE TI~E GROUP 4. NUMBER OF OBJECTS S. LENGTH OP: OBSERVATION JO : U:1t:t I~S 6. TYPE OF OBSERVATION 9. PHYSICAL EVIDfHC! CONCLUSION 11. IItlE, SUMMARY AND ANALYSIS ot~r. -;ould di!:l anci rettrn tftlc rue ..,IS-c:~--:cf..c v U.S. AIR FORCE TECHNICAL INFORMATIOr4 Thla questionnaire has been prepared so that you con give the U.S. Air Forc e as much information os possibl a concerning the unidentified aer ial phenomenon that you hnvtt ob:s~trveti. P lo a.se try to answer as many questions as you possibly con. The information that ycu g ive w ill b used fOf research purposes. Your nome will not be used in connection with any st-:Jtsruenill, conclusions, or publications without your permission. We request this personal lnform{)tion sc that if it is deemed necessary, we may contact you fot further details, 1. When did you see the object? Hout Minuru ltp?J<o1., O?-'JtJ J1t'> ( C irc/e One): A.M. 3. Time Zone: (Circle One): tostern b. Central c . Mountain d. Pacific (Circlo One): o , Doyliuht Sad ng b. Stg.,dard j 5. How I~; waa object In sight? ( Total OwatiOI'I) 6. What was th e condition of the ky? Houra hllnut Sec:o"" 7. IF you acw th o object dur ing OAYLIGHT, wh~r W'l$ the SUN loccted as you loohd Cl th~ o::je::t? (Circltt On.,): a . In front o t you l;,. In oock ~i yoo c . To your fi':Jlf d. To y our left F TO OCT 62 164 Thle '"""' uper .. d .. t'TO 164 , JUI 61, .,hlch h obtolt. 8. IF y ou sow lne object at NIGHT, what di d you notice concerning the STARS and MOON? STARS (Circle One): 8.2 MOON (Circle One): Bri"'t moonlight A few b. Dull moon I ight 6 No moonlight-pitch dark d. Don't rememb.r cr.' Ocn't remember 9. What were the weather conditions at the time yCAJ sow the object? CLOUDS (Circle One): a. Clear aky c. Scattered clouds vh ick ot heavy ciOYds 10. The object ap,.ared: (Circle One): b. T ranaporent WEATHER (Circle One): . c?.' ~g, mist, g, fight roin c. Moderate ot heavy rain o. Don't remember 11. If it op~oted oe a lignt, wae it brighter than the brlghteet stars? (Circle One): o. Brl~ter c. About the some d. Don't know (C irde One): o . Fuuy 01 blurred ~-J-1" J1 Oth t' 11 d. Don't remember 13. Oid the o b ject: (Circle On. for :each queatlon) o. Ap~or t o stand f ill a t ony time? b. Suddotnly speed up ond ruah away ot any t ime? Don' t icnow Don't know c. Brsok up into porta~ explode ? Yes Def1't lcnow d. Gi1~ o ff smoke ? YoJ D~'t know e. Chon9e brir:;htness? f. Change ehaJ>8? h. cl .. ,.,))~t:lt' rnd r,apOitOt? 0 Don't know Oon"t ~now Doo' t ~O'H) DC!f' ' t lcno..., O ld the object disappear while you were .totching it? If so, how? 15. Did the object move behind something at any time, particularly o cloud'? (Circle One): No IF you onswered Y E:S, then tell what Did the object move in front of 'Rmething at any ti me, particularly a cloud? (Circle One): ,/) ~ No Don't Know. . IF you answered YES, the.~ tot!' what 17 . Tell in a few words the following th ings about the objttct: We wish to know the angular aize. Hold a match stick at arm' s length in line with o known ubjed o~ ""'H' ;o.v much of th. ob ject is covered by the head of the l'(latch. If you hod perf<lfmed this experiment at the tirn6 uf the sighting, how much of th~ object would hav' been covered by the ma~h head? 19. Draw a picture that will show the shape of the object ot objects. Label and include In your sketch any detoil of the object that you sow .. uch oa w ings, protrusions, etc., and eapecially exhaust trolls ar vdpor trails. Ploce on arrow beside the drawing to show the direction the object was moving. I ol oht .. 20. Do you think you can estimate the speed of ~object? (Circle One) Yes ~ IF you answered YES, then what s~ed would you estirT.ote'( ---------- - 21. Do you th ink you con estimate how far away from you the object was? (Circle One) Yea {.) IF you answered YES, then how far away would you say it was?--------------- 22. Where were you located w-h~.;-you sow the obfect? 23. Were you (Circle One) (C ircle One): t _ (\ ' t!JIInside a building ~/ ' a. In the business section of a city? (9 lr. rhe residential s~tct;cu .,; a city? b. In a cor c. In opon countryAide? c. Outdoors d. N"ar an airfield?.'~ d. In on airplane (type) e. Flyi ng over o city? e. At sea f. Fly;ng over open country? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete t~e followir.g questions: In order that you con give as clear a picture as possible of what you s ow, describe in y our own words o commOf' obj,ct or objec ta which, when placed up In the aky, would give the some a ppearance at tf1e object which ) ' OU so~ In the followlnt alceteh, lmotiM that you ore \1t the point ahown. Plac an ''Au on ..... r:urv~ lin to ahow ho..,. high the object waa aboote the horizon (tlcyllne) when yc.u first sow lt. Ploc:e ll " Bu on the 1.1me CUf''led line to ahow how high th. object was oboote the horizon (skyline) when ynu lost $t1W it. Place on .. A'' on the eompau when you lltlt lOW It, Place a "B" on the compon where you lost lOW t he object. 28. . Draw o picture that will show the motion thot the object or objects made. P .lace on "A a at the beginning ot the path, a "B" ot the end of the path, and ahow any changes in directl~ during the c~r&e. IF the was MORE THAN ONE oDject, then ),ow mony were there? _f.:./J=~]J CJ.~,L. Drow a pict~e oi h.,... they onanged, ond put an 01row to thow the direction thot they .,e trovoling. 30. Havey~ ever attn this, "a similor object befO#t. If so give dote or dotes and location. 31. Was anyone else with you at the time you sow the object? ( Circle One) 31.1 IF you answered YES, did they ue the object too? (Circle On) 32. Pleou give the following lnfO#matlon about younelf: ADDRESS . zo,. $tete lncllcatt a,., aadltlonal Information about yo,~raelf, lnc:ludlng any apec.lal experience, which might b. pertln"' When and to whom d id you repctt that you hod aeen the o b ject? iA_J _,. r /fl J 34. Date you completed this qustlonnalre: 35. lnformatlcn which you fMI pertinent and which Ia not odequotely covered in the SJ*clffc points' of the quatlonnaire or a narrative explanation of your sighting c;rLr-. J