1. DATE TIME GROUP 2. LOCATION 4. NUMBER OF OBJECTS S. LENGTH OF OBSERVATION 10. CONCLUSION 11. BRI!P' SUMMARY AND ANALYSIS 5 !iinutes 6. TYPE OF OBSERVATION 9. PHYSICAL EVIDENCE FTD SEP 6 3 0-329 (TOE) P"lou IUU ef thh ,_.,,IN iued . U.S. AIR FORCE TECHNICAl IHFORMA li01i Thi a questionnaire has been prepared so t hat you con g ive the U.S. Air Force as much information as possible concerning the unidentified aerial pheno111enon that you hnvu ol;nNeti , Please try to answer as many questions as you possibly con. The information that y<.:u give will be used for research purposes. Your name will not be used in c onnection with any st~teruenl:>, conclusions, or publications without your permission. We request this personal Information se that If it Is deemed necessary, we may contact you for further details. 1. When did you aee the object? 1. fime of da1 _ _jf.-::. ~ .. Hoo.tt Minutru (Circle One): Month Year a. ~Eastern'. (Circlo vne): a. Oaylic:~ht Sod nR t 3. Time Zone: ( C ircle One): b. CentrCil. b. Standard-t c. Mountain 1 d. Pacific 1 4. Where wer yOlJ when you saw the object? State ~ Co<Jnff 5. How long was object in sight? (Total Duration) o, Certai n c . Not very sure , b. Fairly certain d. Just o gueu 5.2 Was object in sight continuously? 6. What was the condition of the aky? a. Sri t I a. Bright b(.Cioudy b. Cloudy 7. IF you sow .the object during DAYLIGHT, where was the SUN located os yoo loohJ c! the o~i~f? _ / (Circle One): a. In front of you b. In bock o f YOY . c. i o your r isj1t:- f. Don't remember 8. IF you saw the object ct NIGHT, what did you not ice concomi11g th e STARS and MOON? 8. 1 STARS (Circle One): MOON ( C ircl-e One): Bti~t mOOillight b. Dull moonlight Many c. No moonlight -pifch dork Don' t remember Don't remember 9. What were the weather condit ions at the time you saw the object? CLOUDS ( Circle One): WEATHER (Circle One): a. C lear sky a. Dry b. Fog, mis t, or li~t rain c . Scattered cloud s Moderate or heavy rai11 d. Thick or h e avy clouds d Snow Don' t r!tmomber 10. The object oppeored: (Circle One): -O.t Solid b. Tranpor.,nt d. As o ltght " Don't t e n,.mber 1 J. If it a pp4110 t .. d (U Q lignt, .WOI I tlf'ignter th~n th. br ighf ur J tcrs? (Circle on .. ): Q, or gnrer c , Abovt tne lOm4 d . Don't kno...,. ( C ircle One ): o. Funy ~ blur,.d " Like a br ight stor c. ~-eutline~ d. Don t ram.mber (Circ/.9 Crn. For .,ach q uetlo11) Appea r to s t and still ot cny t ime? Oon't lcn ow S.,dden ly peed up a nd fush a way a t a ny time? Don' t lcnow Breolc up into parts or explode? Y a s No Don' t lcnow G ive off ~moke? Don' t lcn o e . Chan~ bri~'neu? No Don' t know Change shape? Don' t know Flash or f l ic ker? 0011' t know Y e s No OitC:9l)"Or and reops>ear ? No Doo' 1 '.en ow 14. D id the o b Je c t d isappe a r wh i I~ you werr. II s o , how ? 15. Did the obje c t move behind s o methin g a t a n y t ime, p orticull.lrly a cloud'? (C ircle On"): Don't Kn ow. IF you .:Jo15Wered yr; ~, thnn htll ,..,hot it moved beh ind: 16. D id the objeet move in fron t o f ;;Rmething a t any ttme , porticularly a cloud? (Circle One ): Yes e D o n ' t Know. IF you answered YES. th~., tttll wi1t1l 17. Tell in a few WOfd a the following things about t h e obj~ct: a , Sound tB. We wish to lcnow t h e a n q u lor s ixe. H o ld a ma t c h stick a t a rm' s lemgt h in l inct with o kno wrt ubjec'r o ncl r:"''' ':.. much of the objet:t i s cov~red by t h" htto d o f th e !Tiotch. If you had p_,rf orme d thi s ttX)Jeriment a t riHr tio.'l-; ... ~ ~L., s ighting, how much o f ,;,., ooje c t wou:d ho vlt been covered by t he match head? 19. Draw a p icturs that w i ll s how the $hope oi rh e o bj ect o r o b ject$, L abel and include in your s ketch any detoils o f the o b ject t hat you saw -5uc h oa w ing s , protru s ions, etc., and eapecially e xhau s t trails o r vapor trails. Plat:e on arro w beside the drawing t o sho w t he d irec tion the object was moving. 20. Do you think you c a n estimat e th e speed o f the obje c t ? (( lfC le One) ! F yo.J answe re d YES, the n what speed would you estin.o tt,.1 ------_ - 21. Do yo u think you can e stimate how far away fr om you the o b je c t Wlls? (C i rc/e One ) IF you answere d YES, the n h o w far away would you s a y i t was? 22. Wher e were y ou located when y o.J sow the object? (Circle O ne ): ;J. Inside o bud d ing b. In o car ((.' Outdoors d. In o n a 1rolone ( ty pe ) 2:1. Were yo u (C~tclu Ont!) o . in the business section o f u city? b. Jr, tha f esidentiol S\tt:frc.ol ~: c city? d. N~or an oirfittld? Fl-ying over a city ? f. Fly.n~ ove r ope" c~Jntry'? :. O rne r / 4. I F you wer" ,<,,I)VING I N -\N ..\UTOM081L!: 'Jr othe r vehicle o t t h e lime, then complete t he follo w n. 9 c;ue:ati~s: 2 4 .1 ',&tha t d t re doon were you mov in g ? ((trrle One) a . N o rth .,, So u t h b. N O'th"'c"' d. Sou thea.~ t f. Southwest h. Nortnwf!~t 2~.2 H o w fo<.t wert~ you mov H1J? _ ----- _.mi le s pe r hour. 21.3 Oid you l t o p o f o n y t irne wh i le you wa re look ing ot the obje c t ? 25. Did you obarv~ rhe objecr through ony of the following? Eyeglasses e . Binoculars b. Sun glolSU Winds h ie ld g. Theodolite Ye s Windo w gloH Ye, In order that you con g ive a s cieor a picture a s possible o f what you s o w, d escr ibe i n y our own words a c ommOt: o b 1e c t or o b 1e c h which , when pla ced up in the s ky, would give the s o mf! appearanc e a s the object which )OU ao~ 27. In the followln8 alcetch, Imagine that you ort at tht point ahown. Plo.: u" ' 'J..'' on l~t ~:urv.-~ lmc. to show ho~ high the object was above the horizon (skyline) when yw flr~t sow lt. Ploctt 11 "S .. on th~ s~me c uryecf line 1<' ahow how high the object was above the horizon (skyline) when you last $ttw it. Ploce un " A" on the compou when you ll11t aow it. Place o "B'' on the .:ompou whr you /cut aow t h., ohje~t. 28 . Draw a picture that w i II show the motion that the object or objects modo. Place on "A' at the beginr,;.,R :Jt 1tae path, a "S" at the end of tho path, and show any changes in direction during the .::;urn, 29. IF there wot MORE THAN ONE oblec:t then how many were there? -------------- Draw a p icture of how they were arranged, and put on arrow to show the d irection that they werft tr~vuling 30. Have you ever seen this, 01 a similar object bef01e. If ao g ive date or dotn and location. 31. Was anyone else with you at the tim. you saw the object? ( Circle One) 31.1 IF you answered YES, did they aee the object too? ( Circle One) 31.2 Please list their names and addreues: 32. Please g n following lnf01matlon about youraelf: TELEPHONE NUMB City $tato Indicate any addi t ional information about yourulf, lncludiny any apeclal uperience, which might b. r-rtlnnr . When and to whom did you report that you had seen the object? Cay Month y .. , JA, Date y04J completed thia quutionnaire: 35. Information which y04J feel prtinent and wh ich ia not adequately cove red in the specific ~lnta of the queationnaire or a narrative explanation of your alghting