1. "DATE 'TIME GIOU' 2. LOCATION '. ~ NUMIER 0' OIJICTS Ha.con, Georgia 10. CONCLUSION Ii'ISUFFICI :5111' Dl ... T A FtR ::!:"!/ ALUA 'I! ON Insufficient data. 5. LENGTH OJI OISI.YATION 11. 11111 IUMMA .. Y AND ANALYSIS !Jot Reported 6. TYPE OF OISIRYATION Groum-Visual \fest th~ South 9. PHYSICAL EYIDINCI GlOtring object going ~{est then South. 12-14 inches in diameter. Rourxi estimated at U.S. AIR FORCE TECHNICAL IHFORMATIO_. Thlt questionnaire hat been preporecl 10 that you can give the U.S. Air Force aa muc~ Information as possible concerning the unidentified aerial phenomenon that you hnvo oleervi. Plea try to anawer as many question at you possibly can. The lnforanatlon that yuu iive wiU be uaecl for research purposes. Your name will not be used in connec;tion with any st~tementi.t conclualona, or publication without your permission. We request this personal Information sc that If It Is daenoecl necessory, we may contact you for further detoila 1. When did you ... the obiect? 3. Tin1a Zone: (Circle One): AD Eastam . b. Central c. Mountain d. Pacific ( C ircla One): or (Circle One): 4. Whe were you when you saw the obiact? Nt Ptal Aclclr 5. How long was ollect in sight? (Total Duratten) a. Certain b. Fairly certain City or Tow" c. Not very sure cl. Just a guess . 5.1 How was time in sight determined? ---------------------- 5.2 Was object in sight continuously? 6. What was the condition of the slcy? a. Bright a. Bright b. Cloudy b. Cloudy 7. IF you saw the obiect during DAYLIGHT, where waa the SUN located os you look~d a! the o':!eet? (Citcle One): a. In front of you b. In back of you c. To your rid-t d. To your left Overhead f. Don't remember F TO OCT 62 164 Thle form eupereedee PTD 164, jul 61. whlch te obsolet a. IF you lOW the object at NIGHT I what did you notice conceming the STARS ancl MOCt? 8.1 STARS (Circle One): 8.2 MOON (Circle One}: o. Bri~t lght b. Dvll moonlight Don't ramember c. No moonlight -pitch darl& cJ. Don't rememl.r 9. What were the weather conclltlona at the tl~e you the object? CLOUDS (Circle One): WEATHER (Circle One): a. Clear a ley b. Fog, mist, or light rain c. Scatterecl clouda c. Moderate or heavy rain . cl. Thiele or h~ clouds e. Don't remember 10. The obiect appeared: (Circle One): , d. As a light Transparent Don't remember 11. If it appeatecl os a light, waa it brighter than the btlghteat atars? (Circle One): a. Brighter c. About the same b. Dim,.,., cl. Don't lcnow 11.1 brightness to HIM c~on olaiect: 12. The eclgea of the object were: (C lrcle One): a Fuzzy or blurred e . Other b. Lilce a bright ttar Sharply outlined Don't remember 13. Did the object: (Circle One for each queatlon) Appear to stand still at any th~:? No Don't lcnow Suddenly speed up and ru1h away at any time? Yes No Don't lcnow Brealc up into part a 0# explode? No DOft't know d. G i ve off smoJce? No Don't lcnow a. Change bri~tness? Don't lcnow f. Change shape? Don't lcnow F laah " fliclcer? No Don't lcnow h. Disappear and reappear? Yes Don't know 141. Dlcl the obiect dlaappear while you were t~atching it? ff 50, how? 15, Dlcl the object move t-hincl aomething at any t , particvlorly a cloud? (Circle One}: Don't Know. IF you answeted YES, then tell what 16. Did the oltieet lftO'Ie In front of fRrnerhlng at any time, particularly a cloud? (Circle One): Yea No Don't Know. IF you anawered YES, th feH what 17 . Tell in a few worda the following thinga about the obfct: 18. We wlah to lcnow the angular aize. Hold a match aticlc at arms length in 'line with a lcnown "bject and n~tt,:~ .v much of the oltiect is covered by the head of the rttatch. If you had performed this experiment at the tf of ?he alghting, how much of the ob;ect would have been covered by the match head? 19. Draw a picture that wJII ahow the shape of the object or ot;iecta. Label and include in your alcetch a"1 detc.Ua of the oblect that you saw .. uch as wings, protruaiona, etc., and eapeclally exhaust trailt or vapor traile Place an arrow beside the drawing to show the direction the obiect was moving. I I .tot .. 3), Do you think you can estimate the apHc:l of the obiect? (C Ire le One J IF you answered YES, then what apeed would you esthr.ate't -------- 21. Do you thlnlc you can estimate how far away ..,., you the object wos? (Circle One) IF you answered YES, then how for away would you say it was? --------. 22. Where were you locotecl when you saw the olafect? Were you (Circle One} (Circle One J: In the business section of a city? ~. In the residential sectiGel <Jf o city? o. Inside a building b. In a car c. In opn countryside? d Near an oirfield? e Flying OYer a city? d. In on airplane (type) Flying over open coUntry? At sea : 2~. IF you were MOVING IN AN AUTOMOBILE Pf other vehicl at th time, then complete t~ foUowirt questions: 24.1 What direction were you mewing? (Circl One} - b. Northeast d. Southeast f. Southwest 2~.2 How fast were you nJOing? . ...,~miles per hour. 2~.3 Old-you '"'tit -.y (Circle O.J while you were loolclng at th obiect? Did you observe the obiect through ony of the following? Binoculars b. Sun glosae f. Telescope c. Windshield g. Thodollte Window glaas Yes No h. Nowthweat 26. In ordr that you can give 01 clear a picture as posaible of what you saw, describe in your own wonfa a common obiect or obiects which, when plocecl up In the ally, would give the aame appearance aa the obiect which )'CMI ao 'II, In the fellewlt'f tketth, , ... ,,. thet yeu .. the ,.lftt Pltce " ''J;," on tf..e r.urvr! lin. t h.w ho. hlth the ~IMt WI oltwe the herlaM (allyllne) yw ,,,., lt. Ploce a ..... on the'""'' line to hlth the oltlect the hwlaaft (tlc,llne) when ~ou lt ow lt. Ploco an ''A' on the c..,.,, when reu ""' It, "I" on the c.,...,, where you I' en the oi.tect. 2L . a plctur. will the MOtion the.altlect or oliecta made. P.lace an .. A'~ at the betlnnl"' of the path, a "8" at the encl Of the path, anct an, changes In cllractfon during the cour Drow a picture of how they oi.Ject, then how ,.,., ware there? --------- .,.,.ecJ, .,_,put en row to ah.w the cUraction that th.~ wr trov.Ung. 30. Hove you .. .,_ '"" thia, a almll object bef If 10 elve dote .totes Gnct locttllft. 31. Waa anyone el .. with you at the time you aaw the object? (Circle One) 31.1 IF you onawered YES, ell .. . they '" the oblect too? (Circle One) 31.2 PleoM llat their OM acldrealel: 32. Plea gl.e the following lnfmetlon about f'lrat HIM TELEPHONE NUMBER------- lncllcate on, .clcllt lnformetlon If, Jnclu41nt any apeelol .,.,aence, whldt mieht M pertl 33. When ancl to whoew did you report that you hacl '""the olject?