Memo for The Record: Call o~ 13 Jul 65 TDSW received a call dford, OHIO, 453o8 regarding an observation of his on 12 Jul 65 at approximately 8 pm for 15 minutes. Object was ~lying over Piqua, Bradford is straight west o~ ~qua, object was observed through 7 x 50 Binoculars He felt that he could give more information in letter form where be could draw a picture. Sgt Moody asked him if it was alright to send a copy of FTD Form 164 for him to fill out explaining that it had addi tiona~ space for comments and drawings. Form _was sent to him fj ~t> ...J ( v.Jjf'tJU:A6c. U.S. AIR FORCE TECHNICAl IHFORMATIOrf Thla questionnaire has been prepared so that you can give the U.S. Air Forco as much information as poasiblo concerning the unidentified aortal phenol!enon that you hnvu oLserveu. Please try to answer as many questlona as you possibly can. The Information that ygu give wiU be used f01 research purposes. Your name will not t;,, used In c onnoc;tion with any st~tentent~, conclusions, or publications without your permission. We request this personal lnforrMtfon sc that if it Is doomed necessary, we may contact you for further details. 1. When did you see tho obiect? 3. Time Zone: (Circle One): ra: ~astern !,. ~ntral c. Mountain d. Pacific (Circlo One}: a. Ooylight Sa\'t"9 b. Sta.,dard 4. Where were you when you saw the obiect? City otTo~'" State rw Co nty S. Hew long wa1 obJect In sight? (To~l DUtO~tlon) Hovr a Mlnvtea Sconda ( b; ) Fairty certain d. Just c guess 5.1 How was t lme In si~t determined.? _ _j_.eU~/~Ad.~Jw'::CC.:..d~#.l~:Z}~-....:... ---- 5 . 2 ~as obiect In sight c~tlnuously? ~ '\ No--- 6. What wat the condition of tho slcy? 7. IF you sow tho obi.,ct during DAYLIGHT, where wos fhe SUN located as you l.ook~d '!' the obie~t? (Circlo One}: o. In front of you b. 1n bocl< of y~ c. , 0 f'1.>ltf TISfl d. To your left e. Overheod FTO OCT 62 164 Ttlle fm uper .. dew I'TD 1&4, Jul 61, which Ia obeolete. 8. IF you saw the obiect at NIGHT, what clicl you notice concerning tbe STARS and MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle OM): a. None a. Brldlt moonlight b. Dull meonlight c. Many c. No moonlight -pitch darlc d. Don't remember d. Don't romember 9. What were the weather conditlona ot the tlf?te you aaw the object? CLOUDS (Circle One): " ( a. ~lear slcy c. Scattered clovds d. Thiele or heavy clouds . WEATHER (Circle One): b. Fog, mist, ot light rain . c . Moderate or htovy rain e. Don't rememb4H 10. The obJect appeared: (Circle One): d. As a light b. Transparent e. Don't rei'IMtmb.r 11 .If It appeared at a light, waa It brighter than the brighteat stan? (Circle One}: a. Brighter c. About the ICIH d. Don't lcnow 11.1 Comp.:ar btoi gntnen to ome common obJect: 12. The .dges of the object were: (Circle o~): a. Fuzzy or blurred b. Lllce a btlght star c. Sharply outlined d. Don't rememb.r 13. Did tho abJect: (Circle One few each queatlon) b. Suddonly apood up and rush OWflt at any time? Yes No Don't lcnow c. Brook up Into parts t# explode? Yes No Don't know d. G ivo off smoke? Yo No Don't lcnow e. Change briGfltneu? Yes No Don't know f. Gange shope? : . Yea No Don't know q , F la~h or fllck,r? . Ye~ No D<m't lmow 14. Old the obiect diaappear while you were o~atching it? If so, how? Did the obltet move behiRd tomethlng at any time, partJ~vlarly a cloud? (Circle One}: Yea No ( P;.!!:!_IS. .) IF you canswered YES, then tell what Did tht oliut move In front of to.methfng at any tL'!' ... '!.c.,.e..~!.t ... 'arly a cloud? (Circle One}: Yes No( .,J Oont Know~ .... ,,..) IF you answered YES, thilt\ telt what 17 . Tetlin a few words the following thinga about the object: ' 18. We whh to ~now the angular alze. Hold a match stick at arm a length in 'line with a known ubiect and n1t.c. ~ow : much of the abiect ia covered by the head of the f11Gtch. If you had performed thla experiment at th tlrntJ of the sighting, how much of the object would have been caverad by the match head? Draw o plctu1-a that will show the aha.,. of the ablect or obiecta. Label and Include In your sketch any detoJia of the object that you saw .. uch as wfnga, protrualons, etc,, and eapeclally exhouat trollt or vapor tralla.: Place on arrow beside the drawing to show the dl,.ctlon the obiect waa moving. / . : , 20. Do you thlnlc you can eatimote the speed of the obiect? Q,, ~t.... """'Vl (Circle One) 21. Do you think you can estimate how far owoy from you the object was? Q;,. ~"-'.V'-'~ (Cirde One) ~ IF you answered YES, .then how -for awoy would you aay it was?-------- Where were you locotecl: when-you iaw the ob(ect? (C Ire le One J: Ins ide a building b. In a car In on airplane (type) 23. Wore you (Circle One) a. In the business section of a city? b. In the residential soctiGtl of o city? c:. In opon countrysIde? : . .. : d. Near an airfield? e. Flyi,ng over a c:lty? f. Flying over open coUntry? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete t~e followirg queationa: . ... 24.1 What direction were yCMI moving? (Circle One) b. Northeaat cl. Southeott f. Southwest How fast were you moving? ------~miles per hovr. Old you stop atony time while you were looking at the object? (Circle One] 25, Old you cbarv the oblect thtough any of ihe foil awing? Binoculars Sun glaase' Yes f. Teltcope c. Windahiefcl Theodolite. d. Window glan h. Northwest 26. l., ,,rder thot ou C'Jn glv~ o s c! tHlr a p letvrs ~a p ouible of what y'Ju .sow, d~scribe in y ovr .own '-"'Oth o c o,mon oblect Of' obj$Ctl which, when placed up In the aky, would give the some c:appeorance 01 1h oojct which you IO'W 27. In the following a ketch~ Imagine that you are at the polnt ahown. Place on J.." on the r.urv lin. to a how ho\lr high the o!,lect waa above the horizon (skyline) when yw llrJt auw lt. Place t'l .. 8 .. on the ~me c:ur~ecf line 'o ahow how high the object waa above the horizon (akyllne) when you last saw it. Place on "A'' Oft the compoat when you lltJt lOW lt. Place o "B" on the compott whr you /rut 1aw the al:>iect. 28. . Draw a picture that will 1how the motion that the. obiect or obiecta made._ P.lace an .. A crt the beginning of the path, o "B" ot the end of the path, and 1how any changes In direction during the courae, 29. IF thtre waa RE THAN ONE o , then how many were there?------------ Draw a plctur of how they were arranged, and put an arrow to ahow the direction that they were traveling. 30. Hove you ever seen this, Of a similar obiect before. If 10 ;iv dcte or datea and location. 31. Was anyone else with you at the time you sow the obiect? (Circlo On) 31.1 IF you answered YES, did,they aee the obiect too? (Circle One) 31.2 Plea" liat their namea and addresaea: 32. Please ;lve the following Information TELEPHONE NUMBER ------- tftcllect #Jny additional lnfmatlon obo\lt youraelf, Including any apeelol experlnce, which '"ight b. .,_rtlnent 33. When and to whom did you ~eport that you had 11ten the obi:tct? A ,r . 34. Date you completed this questionnaire: 35. lnformatlcn which you fHI pertinent ancl which It not aclequot.ly covered In the apeclfic pointa of the queatlonMI,. or a explenotlon of ywr sighting. U.S. AIR FORCE TECHNICAL IHFORMATIOt4 Thla questionnaire has been prepared so that you can give the U.S. Air Force aa much information as roaaible concerning the unidentified aerial pheno.nenOil that you ht~vtt oLGerveci. Please try to answer as many question at you possibly can. The Information that yc:u g ive wiH ba uud for reaearch purposes. Your name will not be used In connec;tion with any sto:~ten~nill, conclusiona, or publications without your permission. We request this personal Information sc that if it is deemed necessary, we mav contact you for further details. 1. When did you see the object? Hout Minut" (Circle One): Ooy Month Year 3. Time Zont: (Circle One)!. astern c. Mountain d. Pacific (Circlo One): a. Daylight Sa\ino 4. Where wera you when you saw the object? City or Tow" :s. C.rtoin (9 Falrly certain c. Not very sure d. Just o gueu 5.1 How was time In si~t determined? ,~------------- 5.2 Was object In sight continuously? b . Cloudy 7. IF you saw the object during DAYUGHT, wh~re was the SUN located ~s you lool<ed ~t th., obie~t? ; Don't r-,m~mbor FTD OCT 62 16.S Thla form euparadn PTD 16. jul 61, 'Nhleh h obaolete. 8. lf you saw the objact at NIGHT, what did you notice concerning the STARS and MOCN? 8.1 STARS (Circle One): MOON (Circle One): a. Bright m00111ight b. Dull moonlight No moonli;ht -pitch dcrk d. Don't remember d. Ocn't remember 9. What wera the weather conditions at th time ycu ~ow ~. obiect? CLOUDS (Circ