OA TE 'TIME GROUP l. SOURCE. NUMB.A OF OBJECTS l ClU3 t.::r J.rl LENGTH OF OBSERVATION !.'i nut e:s 6. TYPE OF OBSERVATION PHYSICAL EVIDc~CE i2r-jl:md CONCLUSION r<Arerlt ~ Othar (BI~.D3) :;othi~ pr~oc..1 ted to irt.ic :vcl t.Lt::tt 11. BRIE, SUMMARY AND ANALYSIS of 6-8 ob.:C cts ol)S .rlfed in tcr!.l; t t:::..1 tly .r'...th ~l:it. <.ouL e.s Ol'l.~flu a s .. o CJ. o.u Has c rr1.tic, J.ll brittttneGs a rd. ::u a y . Di:-.ap!:e arcd l.:Johi :rl Obj ccts ;/hi t.e, or -lOW. On l:e.s J.n a i!:c J.' toed Indi vid . .:ll oi)._j3 cts rcturni!'0 3e:tereQCe ia ~to tbe ~t L70 report, vmen ~-w i!~bcitoW4 to tbe ~U.r Fatc:o ror evtslt>aUgo. It 1a tbe ecGCl!laiOD o"Z the Alr Force that tile obJect. '.J!lieb yoa cbe;er'ft<l wre bi~. lni'~r:At.ioo ecnta.1~ 1!1- r re:port; 1Ddie&ted t.be't tboa b'irua euibited tcris ti aim1lar ~ atDrliags. DEPARTMENT OF THE AIR FORCE WASHINCTON O,.I"ICIE 01' THE SECRETARY -Attached is FTD Form 164 which is used for reporting observations of unidentified flying objects to the Air Force. In order for the Air Force to evaluate these reports, this form should be completed as fully as possible and returned to this office. You will be advised of the conclusions reached by the Air Force concerning your report. Sincerely, MASTON M. J~n Major, USAF Public Info ion Division Office of Information FTD Fcrm 164 DamaaC\la, Mar;ylaDd U.S. AIR FORCE TECHNICAl INFORMATI01~ Thia questionnaire ha3 been prepared so that you can give the U.S. Air Forco 011 much information as possible concerning the unidentified aerial pheno111enon that you hovu obllbt'Y~,j. Plaose try to answer as many que.stlons as you possibly can. The information t hat ycu give will be usd for research purposn. Your name will not b" used in connec:tion with any st~terc,~n1:r, conc:luslol"'s, or publications without your permission. We re quest thh personal Information se tha t if it is deemed necessary, we may contact you for further details. 1. When did you aee the object? I. fime of day: .l_Q -- Hov t Minut .. a (Circlo One): or Month v~or 3. Time Zon": ( Circle One ): o, Eastern b. Central c. Movntaln d. Pacific (Circle ,Jne}: a, Ooyli\Jhf Sovii"'O b. Sta11dard 4. Where wet e yov when you sow the object? 3 mi. l!i fXMX1slX Rockville S . Ro.ckyille ~ Md. Montgomery S. How long wa:a objct In sight? (Total Out a tlon ) -""" ~.; C~rtain c. Not very s ure b. f.:lttly certain d. Just a gu,us 6. What was the condit ion of the sky? (a~ Bright a . Bright b. C loudy as dcrl~ stor~ clouds travelel~ eas terwardly 7. lr you sa> the object dur ing DAYLIGHT, 'hra wos th:~ SUN locct~d o:s you locked c! th8 obja-.:t? (Circle On.,): a. In front of you d. To your left FTD OCT 62 164 Th11 !~m eup.,ud n 'TO 164, Jul 61, ,..hloh lw ob olote. 8 . If y ou sow tho object at NIGHT, what did you notlco conceming tno STARS ood MOON? 8.1 STARS (Circl~ One): MOON (Cirda One): Brisht mOOt'lli~t Dull moenlight Mony c. No moonlight - pitch d<:rk d. Don't rmember d. Ocn't r~rr~mh.r 9. What were th.e weather conditions at the tim you saw the objoct? CLOUDS (Circlo One): . WEATHER (Circle One): Clear sky V. JJ Of li.ih~ mln- c. Scotter~d clouds V e. Mcderat~ or heavy rain Tniclc or Hbovy clouds Don't remember 10. T ho obj.:sct oppeored: (Circle OM): d. As o fight b. r rcnspar'!tnt o . Don' t rememb.r 11. If It opp#jcr.-d 0.1 o li~t. vras it bri~htr than the bright.ut s t ars? (Cirde One}: a. Br!ghter j 12. 7he 8Cges oi tne .,r,,cr were: (5) Abovt the some d. o~ know . (Circie 0,.,): t 1. fvn y or blumtd b. Like o bright stcr c::. Shorply ootllnd d. Don't r~memb.r 13. Did the o b i,cf: b. Suddenly sp~ .,.d vp and ru ;s), a way o t ony H rn? c. Br"ok up in to port~ cr ~ucplcd-~t? d. G ltll off smo!<~? "' Chonfi1t bris}ltne3.l? 1. Chcn gtJ :shop.,? Doo'! bo-N ~se;e i t ern Dc.n't tc~"w Dc:n't know 14. Did tho objecfdisoppear while you were 'dOtching it? If so, how? In and out of the clouds , up and down, back and forth but steadily moving forward 15. Did the object move behind somethmg at any time, particularly o cloud"? (Circle One): IF yo u .:Jo'\SWerotl Yf;~, tht~n htll what it moved behind: 16. Did tho object move in front of !>Pmething at any ti me, particularly o cloud? (Circle One): Don't Know. IF you answered YES. the,, t<tP w h(JI in front of: _ 17 . Toll in o few words the following things about th~ obj~ct; a. Sound Too far to .h -anything--at le{l._st 15 miles. ------- 18. We wish to know the angular size. Hold o match stick at arm' s length in line. with o known ubjoct and n-t1{. !oc.;w much .of thi!t object !s -covered by the head cf Jhe l"(latch. If you hod pfrformed this cucperiment at the. tlr,.,~ l.lt ?l:e slghtin~, how muo;:h of :he object would ~ave b.ten covered by t he match head? only a part of the head of the match wo 1l d be covered. 19. Draw a p icture thot w il l show the sho~ of the object or ol>jects. Label and include in your sketch any detoil~ of the object that tou sow -such as wings, protrusions, etc., and especially exhaust trail or vapor trails. Place an arrow beside the drawing to show the direction the object was moving 20. Do you think you con estimate tho spaed of the object? The c luster of to objects was progressing at about 5 miles per minute; individual objects flitt from and returning to tpe cluster (Circle One) IF you answered YES, then what spead would you estinoote~ '<'ere trayEl_ling a a.tel 0 21. Do you think you con estimate how far away from you the object wos? (Circle One) If: you answered YES, then h o w for away would you say it was? abE_Ut _1:5 or more rni les 22. Where wen' yo u locot ttd when you saw the object? (Circle One): G Inside a building -7th floor b. In o cor c. Outdoors In an air plane (type) 23. Were ycu (Circle On~) o. In the business section o f u city? (9 Jr, tha residential soct ic.. t v( a city? c. In op<Jn country~ide? d. Near an air field? e. Flying over a city? f. Fly;n{i ever open country'~ 24. IF you were MOVING IN AN AUTOMOI31LE o r other vehicle a t the tim.,, then complete t~e followir.g quntions: 24.1 What direction were you moving? (Circle One) o. North c. East e. South b. Northea3t d. Sout heast f. Southwest 24.2 Ho"" fast WPJre you moving? miles per hour. 24.3 Did you ,too Qf ony time Nhiltt you 'ere looking a t the object? (Circ;/a One / 25. O id yov observe the obiect through ony o f the following? Eyl'!!~losse e. Binoculars b. Sun glas'\es Yes No f. Windshield g. Theodolite @Window g loss Yes h. Northwest 26. In order that you can give as clea r a picture a s posaible of what you saw, do1cribc in your own words a comrr.oo objec t or obj.,ct:s which, when plocod up in tha sky, would give tho some app-.roronce os the object which ) 'O'.J :sow vfhite, round -maybe flat In th follow In; alceteh, lma$Jine that you ore at the point shown. Ploc:e em "J.." on tl-.e ~:urw.~ I in" to a how ho..., high the object woa above the hlzon (s"yllne) w.hen yw llrst 1ow It, Ploeit ll "B" on the a:Jme cur't'd li ne 1<' ahow h~w high the objct was above the horizon (skyline) when you lost tSCIW it. Place on "A,. on the comp11u when you llr2t 1ow it. Ploc:e o "B" on the ~ompon whr you hut aow rh o hject. 28 . Draw o picture that will show the motion that the object or objects mado. P.loco on "A" at tho b-oglnnln g ot ~he path, o "8" ot the end of tho {oth, and ahow any chongos in directio~ during tho couru. ; 29. IF th,.. wa.. MORE THAN ONE obltct~ then how many were ther? ---------- Draw a picrvr oi ho-v thy wr arrongd, and put an 01row to sh~ rhe direction that they were travulillg. 30. Have you ever :seen this, or a 'imilar object before. If so give dote or dotes ond loc:o tlon. 31. Was anyone else with you at tho time you saw the object? (Circle One) 31.1 IF you answered YES, did they ue the object too? (Circle Ono) 31.2 Please l ist their names and addresses: & Geodetic \'Jashington Science S . Rockville, Md. 32. Pl~a give the following Information about youraeU: Mlclclle NoiM City Zon. Stato TELEPHONE NUMBER trdlc:at Ol'l~ oddl! lono! ln forrnatlor, about ;~ur .. lf, lneludl,9 oh~ peclol experience, whlc:h mignt b. ~rtlnent. When and tQ whom did you repett that you hod seen the object? Information Division of Information ~. Dot you compltd this qu .. tlonnolr: 35. lnformoticn which you feel pertinent and which ia not adequately covered in th. apeclflc polnta of th. quationnoire or a narrative explanation of your sighting.