1. DATE TIME GIOU' NUMIEI OF OIJECTS LENGTH OF OISIIVATION 6. TYPE OF OISEIVATION 2. LOCATION PHYSICAL EVIDINCI H< .rr.)nL "]_ c :i.n In the felltwlftl eketch, I I thet you .,. tit the ,.lnt eken. Plc o" .. J. ... on th ~:Ufv.,.~ h" te ehew h._ high the oittect wae oiMwe the horla (ekyllne) when yeN llrtf lt. Place IJ .. B .. on the cur1eclllne tc-, ehow how high the oblect 1 oltoe the horizon (llcyiiM) when you lof '""' it. Place an ''A'~ on the compos when yeu ''"' w lt. Piece "I" on the c 11 where you lot the ol.ject. 28 . Draw o picture that wi II ahow the motion that the obiect or objects made. P.lace an "A at the begannl~19 at the path, a "8 at the end of the poth, and ahow ony change in direction during the c~rae. 29. IF there woe MORE THAN ONE oi.Ject, the" how IM"Y were there1---------- Drow o picture of how they were arrongecl, oftd put on row to ahow the cUrection that thy wer trovling 30. Hove 'fiN ever aeen thia, 01 a aimilor o~ic! befe, If 10 give dote or d1te1 oncj locotiOft. 31. Waa anyone else with you at the time you aow the object? (Circle Ott e) 31.1 IF you onawered YES, di .. they e the obiect too? (Circle One) Pleaae lilt their names and ocldreaaea: .vv1:; 32. Please givt the following Information about younelf: TELEPHONE NUMBER --..: 33. When anct to whom did you report that you had '"" tht obtect? 34. O.te you c....,letecl thit .,.,tlonnalre: 35. lnfMtl which you fMI peatlnent ancl which It not oclequotly coverecl in the 1peclflc polntl of the onnelre 011 a explanation of yOVt elghtlng H.ADQUAIItt lllltS FOREIGN TECHNOLOGY DIVISION Atilt f'OIItCE SYSTEMS COMMAND UNtTaD 8TATC8 AI" "O"CC Wfne .. T~ATTC ... ON AI" "O"CC OHtO s ueJtt.': UFO Observation, ro: Hq USAF SAP'OI-CC (Mrs Bunt) Waeh D c 20330 e ia in receipt ot a letter from Sr o~ addressed to Defense S ID hie letter he reported an unidentified fl11D8 object on the nisht of 20 Apr 65. Since his letter did not contain autticient 1ntozsu1Ation tor luation, 1 t is requested . tbat your o:rtice forward an FtD Form 164 to him tor let ion .l'OR THE! Y()tJ-THE NUCLEUS OF SECURITY' ---~ laWIIlcda~ ...a to thla otnee U.S. AIR FORCE TECHNICAL IHFORMATIO Th, s questionnaire has been prepared so that you c<m y ive the U.S. Air F or~ as mu'h information as possible concerning the unidentified aerial pheno.net!on that you ht~vtt oLseNti. Please try to onswer as many questions as you possibly can. The information that :;c:u ~ive wiU be used fet research purposes. Your name wi II not be used in connec.;tion with any st~trreni;;, conclusions, or publications without your permission. We request this personal information sc: that if it is deemed necessary, we tnay contact you for further detai Is. 1. When did you see the ob;ect? 3 . Time Zone: (Cude 0.1~): a. Eastern ~ c .,ntral c:. Mountain d. Poc:1f i c [Circle One): A.M. ( Circle t)neJ: o, Oayli9ht So:rq b. 5tOW1dard s. How long WOI ooict in sight? (Total Durtl~) Hour a Second o. Certain ~ F ~irfy certain c. Nor very sure d. Ju 1t a ueJ~ s.l How wos t ime in sight determined? -L~!d.a::..2:2.: 5.2 Was objct ;n sight continuously? 6. What waa the condition of the alcy? a. Bright. '(a} Bright 7. 'F you aw the obiect during DAYLIGHT, wnere was rhe SUN foccted os yo~ loc,k~J .:! the oe;~t? (Citcfe One): a. In front of you b. tn back of you ~. To yovr ri~t d. To yovr left e. Qverhe od f. Don't remember a. IF you .so .. 'olt: lt.,eC1 ar N l HT, what dtd 'fOaJ notice CCJI"Cetning the STARS and MO~? 8.1 STAR~ (l.rcle One). ct. Don't re'"mber 8.2 MOON (Cirt:le One): a. Bri~t moonl1ght ,"c. Nomoonlight -pitch aai~.; cr.oentr.me-mbir- -- 9. What were the '#reather condition at the time ycu saw the obiect? CLOUDS (Cin:ie One): ~ , Clear ally.) c. Scattered cJoyds d. Thiele cr heo.,y clouds WEATHER (Circle One): b. Fog, mist, or light roin e. Moderate Ot heovy rain Don't remember 1(]. The obiect ~ppecrftd: (Cirde Ont~): ( g, Solid ... a. As : f e9nt b. Tral'apcre~"'~t 8. Oon't rrne,O.r c:. /opot (C irc!e 0"' G. Fu :zy Ot blurred (e. 5narp1~ out I ined) -d. Don't ;.member 13. Did the obtect Apc~eor to stand stilt nt ony thttl? Don't lcnow Suddenly speed yp cmd rvah away ot any time? Don't lcnow c. Brealc up into pa"s 01 plode? 00ft't know Give oH \molce '> Don't l&now Cftan~ b-i ~ tne s s? Don't lcnow Change sha~? Don't lcnow F!osh Ot fli clcer? Don't lmow OisappoeJr ~d reapp.cr? Oon't know 14. Did the obiect disappear while you were 1atching it? U so, how? 15. Old the obiect move behind something at any time, particvi\Jrly a cloud? (Circle One): Don't Know. IF you .:.answeted Yf!S, then tll what It moved behind: 16. Did the object move in front of emething at any time, porticularly a cloud? (Circle One): ~ No Don't Know. IF you answered YES. the., t~H wi1<Jt 17. Tell in a few words the follo'tlr ing things about rhe nbt~ct: . b. Color 18. We wish to kno.-the angular s 1ze. Hold a match ~tick at arm , le,gth in l inct with ci Jwown ubiect Oft~ 110'' t.;~ muc~ of the object I t cover'!d by the head of the lfiO'Ch. If you had performeJ this experiment at ther tir""'.; . t ~1.1! sighting, how much of the ob;ect would hove been covered by the match head? 19. Draw a picture tnot will show the shape of the obiect ot obiects. Label and include in your aicetch any detQ;f~ of the abiect that you saw .. uch as wings, protrusions, etc:., and eapecially exhaust trails or vapor trails Place an arrow beside the drawing to show the direction the obiect was moving 20. Do you thinlc you can estimate the speed of the obiect? (C ire le One) IF you answereci YES, then what speed would you eatirr.ote'f 21. Do you think you con estimate how for away from you the obiect was? (Cirde One) IF you answered YES, then how far away woulci you say it was? Where were you located when you sow the obfect? (Circle One): .(!) inside o building b. In a cor c. Outdoors d. In on airplane (type) e. At seo 23. Were yew (Circle One) a. In the business section of a city? b. Ira the residential 5\lctic.;e ~; a city? c. In opon countryside? d. Nttor on oirfiefd1 e. Flying over o city? f. Fly ~ns; over open country? l 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, theo complete the followie,q queati""s: 24.1 What direction were you moving? (Circle One) c. East e. South b. Northeast cf. Southeast f. Southwest h. Northwest 24.2 How fast were you moving? . .miles per hour 24.3 Oici you 1top at any time while you were looking at the obiect? Olci you observe the obfect through any of the following? a. Eye9foaae1 Binoculars Sun ;loa Windshielci Theodolite Yea No Window glaaa In order that you can give aa clear a picture as possible of what you saw, describe in your own words a common obiect or ob;ects which, when placec:J up in the alcy, would give the same appearance as the obiect which )'OU sa