1. DATE l'IME GIOU' Civ:i l :i:ln ~. NUMBER OF OIJECn 5. LENGTH OF OUIIYATION 6. TYPE OF OBSERVATION 9. PHYSICAL EVID!NC! 2. LOCATION 10. CONCLUSION 11. aiiEP IUMMAIY AND ANALYSIS h;]l' 'il IIJ"'H 0 up. i lf.! r ert'fl t ' 1. &ATt 'riME GROU' 2. LOCATION .n/t' ~OOZ 10. CONCLUSION Ci vilin 4. NUMIER OF OIJECTI 5. LENGTH OF OBSERVATION 6. TYPE OF OISERVA nOM 9. PHYSICAL EVIDENC! 11. IIIIIP IU-ARY AIG ANALYSIS U.S. A.1R fORCE TECt-1t-lJCAl IHFORMATIQ,~ T l; \ qu.-~t,,>r,,'lu! ~ has he,n prepared so that you can !J;.,e the U.S. A.r Force as mu~h i"fotm(JfiOI1 'ls po.a,,o}., concerning th unide,ifiad ue: ,.JI phenr."ner'or that you hravu oLse"'ti. Please try to cm<;wer os many quest! ons as you pos sib 1, con. The information that )'(;U ;;ve w:n b., u'd f(,j( re5ec.u c h purposes. Your name will ,,ot b..t used in connec;t;on with any st~tenni;, conctu.SJons, or publications with~ut your per.-rH5Si.Jt., We request this personal infoim:ation ~c: that iF it is deemt~td nec~sscny, ws may c:ontact you f<.W further de~ails. 1. When did you sf!Je the ob;.,r:t? \ ( ircle Onft): or J T i me Z v n e J, CO!if8J" ~OUrtfO lfl ( Circlt" .Jne,1: o. Doyli~;ht So :ti"O b. Sto.,dcud ~ s tina a :,e i J, Bright i C ,,de Cn~ i. tJ . In front ...,, you b. Jn hock ~r 'I~ e. To ytXJr g ' t " Q Y, r neoJ f . Don~ t r.,rr-.mber 8. IF you saw th~ obiect at N1GHT, what did you notic concerning the STARS ond MO~? 8.1 STAR.) (Circle O"e ): '...C~ Many d. Don't remember 8.2 MOON (Circle One): a. Bri .. t moonlight b. Dvll moon I ight ~ No moonlight -pitch darl& cl. Don't remember 9. What were the weather concfitions ot the time you saw the obiect? CLOUDS (Circle 0,.): WEATHER (Circle One): a. Clear ally b. Fog, mist, Of light roln c. Scattered clouds c. Moderate Of heavy rain Thick or heavy c iovds e. Don't reruember b. Tronap,,.~fll c:. Vo JH, o d. As o ''ghr e . Don t r"tm.mb.f o . U 1 tl~Ntr :. A bovt ~. same F v : :.v Of b lurrd b. L i Ice o bti~t s tar c . 5narply outlined d. o~'t remember 13. Did tJ,e obtec t : a. Appear '~ stand st J If at any tim? Suddenly ~peed up and tush OWG)' atony ti1r1e? Brealc up into porta ..-. plode? d. Giv off smolce? Change b-i~tness? Change :~hape? F Josh ~ il i clcer? Oieac r ~Jnd reopo-tc r ) (Circle One for e.ach queation) Don't lcnow Don't lcnow Don't know Yes No Don't lcnow Don't lcnow Don't lutow o.,., lcnow 14'. Did the obiect di 1appeor while you were 1atch ing it? If so, how? ~lrn3d 11m r, cli~b~d in th~ tjistance. 15. Did the obiect move behind something at any time, particuhuly a cloud'i (Circle One): Yu No Don't Know. IF you .:a.,swerecl '(:;,, then tll what it moved behind: _J:t_rsQYfld be.hind see bri~b.t 1 i~ hts in tha distance.! ~be>~t, . -- a Mile away) aR it 1i~}l.annearl!1. 16. Did the ol:aiect move in front of omething at any time, particularly a cloud? (Circle One): Oon't Know. IF )'OU answered YES. ""'!M t .. P wi.c'lt 17. Tell in a few words the following things about the obict: 18. We wish to know the ongulor siz.e. Hold a match sti~k ot arm-. length in line with a lcnown ubiect ant4 n~J~ ~N muc:h of the object is cover:td by the head of the fllOtch, If you had performed this experiment at lh~r tir:-w.; .J t 1t.~ sighting, how much of the obtect would ha-,e been covered by the match head? 19. Dr a picture that wifl show the shape of the obiect or ot;jects. Label and include in your aketch any det~il of the object that you saw -such aa wings, protrusions, etc., and especially exhaust trailt or vapor trails. Place on arrow beside the drawing to show the direction the obiect was moving. 20. Do you thinlc you eon eatimate the speed of the ob;ect? (Circle One} Yes No IF you answered YES, then what speed would you eltin-.ote'f _P"_l_r_e_.;..'-_' 21. Do you think you can estimate how far away from you the object wos? (Cirde One) IF you answered YES, then how for away would you say it was? 22. Where were you located when yov sow the oblect? (C irc/e One): 23. Were yo" (Circle OM) o. Inside a building b. In a car c_.) Outdoors d. In an airplane (type) In the business section of a city? lr. rha residential S\tCfic,ea ~i G city? In opc.n country~ide? Near on oirfiefd? Flying over a city? Fly ;n{i over opere country? 24. tF you were MOVING IN AN AUTOMOBILE o r other vehicle at the time, the" complete the folrowi-~9 questions: 24.1 What direction wer you moving? (Circle One) North c. East e. South b. NDftheost Southeast f. Southwest h. Norfflwest How fast were you !'11ovi ng? miles per hour. 14.3 Did you stop at any t ime while you were foo~ing at the obiect? (Circle One) Did you observe the object tnroygh any of the following? Eyeglaase e. Binoculars b. Sun glaasea Yes No f. Telescope Windshield Theodolite Window glass Yes 26. In order that you can give as clear a picture as possible of what you saw, describe in your own words a common obiect or obiects which, when placed up in the slcy, would give the same appearance os the obiect which ~ou so-. ~!o co-,:11~n ob.1~ct, i+, j 'tst an"'~ar~ri a.~ a r rYtni t o t?Yal ~ha ri bri~ht li~ht. In the fellewlftl alletch, I IM thet you the ,.lnt ehewn. Place o" J..'' o" 1ht '-Urv~ ltn thew hen. high the eltict 1 altoe the horlaen (tlcyllne) whn yeN llrt tow It, Place , ''B on the 1.1me c;ur~e4 line SC'o thow how hlth the c*iect was obcwe the horlaon (skyline) when ~nu last ~c.w it. Ploce \1ft 'A'' on the compaa when yeu llr' It, Ploce "I" .,. the co,. where you lo1t the oh;ect. He ~as ltttle haz7 on 28. . Draw a picture that wilt show the motion that the obiect or obiects made. P.lace an "A' at the beginni.1f1 ot rne path, a "8" at the end of the path, and show any. changes in direction during the .:::rut!.e. IF there was MORE THAN ONE lct, then how many were there? .. _ - Draw o picture of how they w.,e orrongecl, ond put on wrow to show the direction that thy wer traveling 30. Hove yOAJ ever seen thia, or a similor object bef If ao eivt dote or dcnea an_. locotion 31. Was anyone else with you at the ti you aaw the obiect? (Circle One) 31.1 IF you answered YES, did they the obiect too? (Circle On) 31.2 Please liat their names and ocldreaaea: Ketterin1, 32. Please give the following lnfOtmatfon about younelf: TELEPHONE NU~B Indicate ony additional information about youraelf, including any tpeciaf prince, which mi~ht be pertinent 33. When a~ to whom did you report that you had n the obiect? ... hi ~ i s iri ~.,ial r Y)ort tin1 i s te> Ca:1t. U. Dete yeu c....,letetl this .,.stlonnalre: 35. lnftMtiM which you fMI peutlnent and which Is nat aclequately coverecl In the specific polntl of the .,..,,.,....,,. a explanation of your slghtlnt ~ obj~et~ b~ca~e di d in b3t~e~n r~al bri,ht (br1bhter than th~ bri~ht3~t star) Posi tiYe that they Her~ not .i~ts or aircraft. at til'1'!~ and 0/lf'OIJ, o tt1o. ~NDCe te :t1on v1tb tbe Dlt7 Offteer o~ liD oa the ot 1 Apr 65, JOar ot 1 Apr 65. 'ftM D1't7 Otncv' d14 DOt ccmtaiD .nic1ellt uu~or w would appreciate raur till.ins out tbe attached ltD Pom 164. We are alao at a self ed lope tor e 1n We viah to JtG tor U.S. AIR IIORCE TECHNICAL IHFORMATIOH This questionnaire has been prepared so that you can give the U.S. Air Force as much information as possib .. concemlng the unidentified aerial phenomenon that you have observed. Plea try to answer as niCiny questions 01 you possibly can. The Information that you give will be used for research purpoaes. Your nome wi II 110f be used in connection with any atatements, conclusions, or publications without your permission. We requt thia personal information so that if it is dNmed necessary, we may contact you for further details. 1. When did you sH the obiect? Month Year 3. Time Zone: (C irc:le One): o. Eastern c. Mountain d. Pacific 2. Time of day: ----- (Circle One): (Circle Otte): a. Doytight Saving b. Standard 4. Where were yOY when you sow the object? Nearest Postai Ado'""' City or Town State ar Co~.onty How long was obiect in sight? ( T ota I Durotton) Hour a Minute Seconds Not very sure Fairly certain d. Just a guess How was time in sight determined? Was object in sight continuously? Yes No 6. What was the c:ondition of the sky? 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object? C itcle One): a. In front of you b. In bock of yCY.J c. To your ,;g,t d. To your left e. Overhead f. Don't remember 14. Did the obiect disappecw while you were watching it? If so, how? 15. Did the obiec:t move behind something at any time, particularly a cloud? (Circle One): Yea t No Don't Know. IF you answered YES, then tell what 16. Did the obiect move in front of something_at any time, particularly a cloud? Don't Know. 17. Tell in a few words the following things about the object