1. DATE TIME GROUP 2. LOCATION 10. CONCLUSION 4. NUMBER OF OBJECTS trhiJ i/c f1 Lht in 5. LENGTH OF OIS!AYATION 11. IIIIP IU .. AAY AND ANALYSIS I! o n :.;t.Pl t i . .:l:: :1':.Lrih.ll:, rl t.,o illu::j l 6. TYPE OF OBSERVATION ro unrl-I i~, tal 9. PHYSICAL EVIDENCE No rJ:J tuYl U.S. AIR FORCE TECH"ii~.Al OP~ATIOt-1 This questionnaire has been prepared so that .,CJv ~'-in g;.,. th U.S. A, Fore" O.!t m~ch Information as poaaibfe concerning the unidentified aerial 1-ihenomtt:non that yov h~vo o~servd. Please try to answer as many questions aa yO\I possibly c~f1. Th" information thot vou give w:lf be used for research purposes. Your natne will n()t b! u.sed in C: )r.r~er.t;oo .,,ith any stat~."M,,~:.., conclusions, or publications without your permissior1. Ws request this persvr.al Jnfo,"rtOtien ~c that if it is deemed neceseary, we may contact you for further details. 1. When cU~ you '" the oblect? Day Mant)t Year I \_.... . 3. Time Zona: (Circl~ One):, a. Eastern b. Central :. Mountain d . Pacific Circle One): _f!: Ooyiiuht Save,s (0. ~ Standard ~. -lfhere wr yoo when yoJ sew the object? Heorest ?ostol AcJdreu 5. How long was obiect in s1ghr? {Total Duration) c. Not 'iery surtt .d. Just a guess S.2 Was obiect in sight continuously? 6. What was the condition of the slcy? 7. IF you saw the obiect during DAYLIGHT, where wos the S\..ii-1 located os you looked,_,; the obt : (Circle One): a. In front of you b. In back of you c. To your ri~t 8. IF you saw the object at NIGHT, what did you notice conceming the STARS cn,j MOON? 8.1 STARS (Circle One): MOON (Circle One): a._....Bript anoonlight a. Dull moonlight c. No moonlight -pitch darlc Don't rameml.r d Don't remember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): WEATHER (Circle One): a. Clear alcy T. Fog, mist, or..Jight rain c. Scattered clouds c. Moderate or heavy rain d. Thiele or heavy clouds Don't remember I 0. The obiect appeared: ( C irc/e 0~): d. As a light b. T ran a patent e. Don t rensemlter 11. If it appeared as a li;ht was it brighter than the brighteSt stars? (Circle One): . a. Brighter c. About the same b. Dimn:er d. Don't lcnow 11.1 Compare brightness to some common obfect: 12. The edges of the object were: (Circle One):~ Fuzzy or blurred b. Lilce a bright star c. Sharply outlined d. Don't remember 14. Old the o~;ect disappear while .You were -..~ten ing it? Jf so, how'! 15. Dicl the obiect mOe behind something ot any time, particularly a cloud? (Circle One): No Don't Know. IF you answered YES, then reH what I It moved behind: 16. Did the obJect move in front of somthing at any time, p:articulorly a efoud? (Circle One}: Yes No Don't Know. 17. Tell in a few words the following things about the obiect: 19. Draw a picture that wi II show the shape of the obiect or o!;iectl. Label and inc l~de in yot~r s:<e:~h .::n~ d~. 01 h of the obiect that you saw 'Such as wings, protrusions, etc., and especially exhaust tr~i!s or vo:~pcr trr.\~::. Place on arrow beside the drawing to show the direction the obiect was moving. Do you thinlc you can estimate the speed CJf t+,e obiect? (Circle One) Y~ 'f No IF you answered YES, then wha; ~peed would you eS!imat~t? J '' 21. Do you thinlc you can estimate how far owtJy from you the ?b: .. c t wos? (Circle One) Yes c No IF you answered YES, then how for away would you say it waa? --------- 22. Where were you loccTed when yov saw th ob;ect? (Circle One): \a. Inside a building 5. In a car e. Outdoors d . In an airplane (type) j 23. Wt!ire you (Circle One) I a. In the busine11 section of a ~aty? b. In the residentia! aectton ~fa c!ty? In open countryside? d. Nar an airfield? e. Flying over o city? f. Flying over open co-Jntry? 24. IF you were MOVING IN AN AUTOMOBILE or other vtthsd., ot the tirr.'-th~, ~o,ol~te the ~o!tcd~g .~tJ.")~i tor.s: 24.1 What direction were yoi.i movin~? (Circ le One!) b. Northeast d. Southeast f , Sov th wes 1 h. N,;rthW9.i7 24.2 How fast were yOY -r.ovirog'? m iles per hour. 24.3 Did you Jtop atony ti me whlle yo.J were looking ot the obiect? 25. Did you observe the object tnrough any of the following'? Eyeglasses Yes Binoculars b. Sun glasses Yes Windshield Theodolite Window gloss 26. In order that you can give as clear a picture os possible of what you sow, describe in yaur e w:-worA r. " ~ :;:--r obiect or objects which, when placed up in the sky, would give the ~orne appeoronc~ 05 ~ ~ "~jnc! .,.,~ -~ yt;.,J .~ In the following slcetch, i~agine thcat you are at the point ~hown. Place 'ln "'A' ' .m curvd lirte to show how hiQh the oltiect was above th horizon (sicyllne) wJ,en y ou fir~t sew it. Pl.:c;"" "t5'' on th S<itne :;tJNed liN to show how high the obiect was above the horizon (slcylinJ ""hen yau lost~ ; .. t~. : when you llrst saw it. Place a .,8" on the com~ass wh('!~o yQu la.st 5-l''"' 'r~ of ..... '=' 28. Draw a picture rhat wi II snow the motion thct the object or obj~cts m-: . P !cc:.l \ln ' .t." ~t 1h11 h.~ 11nH'!~ of she path, a "8" ot the end of ~he path, and show Of'Y chanQet!\ in direction d:.trHtg rh4 c~.,., 29. IF there was MORE THAN ONE Qbjact, then how many were there? _ ---- --- - .. - . '-. Draw a picture of how they .,.,.,.arranged, and put on arrow to snow rh e dirscti<Jr .nc; :.,~Y :er~ uaveli.ng. 30. Hove you e.,er sen thil, or a similar obj.,ct before. If s ., giv.t dote or dut~ 1:11~ location. 31. Was anyone else with you at the time you saw the object'? ( Ci,:le Onei 31.1 you answered YES, did they see the object too? (Circle One) 31.2 Please list their names and addresses: .,_ 32. Please give the following information about yourself: L.oat Nome First Nome Street c;,)' Indicate any additional i nformation about yourself~ includtng any tpeciol experience, ""fhi ch ,r,;gnt ~ r; n r. :'L 33. When and to whom did you report that you had seen th object? U. Date JOU completed this -,,. on which JOU '"' perti-- ..,. .... :~,..d in the tpeciflc polnta of the Ire or a narrative pa.,.