fF yoo onswered YES, then what speed would you estimate? J. (Cirzle One) IF you onswered YES, then how far away would you soy it woe? a. Inside a building e. At sea 23. Were you fCirc/e One) o. In the business section of o city? b. (n the residential section of a city? c. -In open countryside? d. Near on oirfieid? e. Flying oyer o city? f. Flying over open country? 2d. IF you were MOVING IN AN AUTOMOBILE or other vehicle ot the time, then complete the following questions: b, Northeast d. Southeast f. Southwest .miles per hour. (Circle One) h. Northwest 25. Did you observe the object through any of the following? Eyeglasses e. Binocuiors f. Telescope Windshield Theodolite Window cl-ss appearance 29, IF there wos MORE THAN ONE object, then how many were there? Draw o picture of how they were arranged, end put an arrow to show the direction that they troveling. 3]. Was anyone is wifh you at the time you saw the object? (Circle One) 31.2 Pleose i^'st their names and addresses: 32e pleas# give the following information about yourself: TELEPHONE NUMBE Indicate ony additional information obout yourself, including any special e^perienca, which might be pertinent 33. When ond to wnom did you report thot you had seen the object? cT* questionnaire; 35 InformoHon which you foel pertinent and which is not adequately covered in the specific points of the questioonoifo or o ncrratfve explanation of your sighting* CHRISl'MAS TED (nJSW) Vrl^t-Patterson AJ3, Ohio 5 Janaary i960 Srvinf PftnaaylTaata Reference your uaidentined observation of *Joveaber; ^e ixUTorvatlon i*loh ve received was apt sufficient for evalu* atloa* Bequest you coe^lete the attached FTO ?co l64 and. return It In the envelope provided. your observation to the qpriTAaiLIA^ U.S. AIR FORCE TECHNICAL INFORMATION Thts questionnaire has been prepored so that you con give the U*S< Air Force as much informorion os possible concerning the unidentified oeriol phenomenon that you have observed, plaos* fry to answer os many questions os you possibly con. The information that you give will be used for reseorch purposes. Your name will not be used in connection with any stotements, conclusions, or publieotions without your permission. We request this personal information so necessary, (Circle One); q. Daylight Saving itt'o'nddr^ d. Poctfic e. Other _ 4. Where were you when you saw the object? N*orit Peitol Address Fairly certain re in sight determined? continuously? What was the condition of the 7. IF you saw the object during DAYLIGHT, where was the SUN locoted as you loolted at the object? (Circle One); a. In front of yo c. To your right d. To your left e. Overheod f. Dcn't remember Tht for*n 8. IF you saw the object of NIGHT, what did you notice concerning the STARS ond MOOH? 8.2 MOON (Circle One): d. won't remember Bright moonlight Dulf moonlight blQ.moonllght - pitch darC^' Don't remember 9. Whot were the weother conditions at the time you sow the object? c. Scattered clouds d. Thiele cr heavy clouds rt'EATHER (Circle One); Moderate or heavy rain 10. The object appeared: (Circle One): b. Tronsocrent 11. It it oppeored os a light, was it brighter then the brightest stars? (Circle One): c. About the some d. Don't know 11.1 Compore brightness to some common object: 12. The edges of the object were: O.'^e ): 'q. Fuxiv or blurred c. Sharply outlined d. Don't remember 13. Did the object: a. Appeor to stand still at any time? b. Suddenly speed up ond rush away ot any time? c. Break up into parts or explode? d. Give oft smoke? e. Change brightness? f. Change shape? g. Flash or flicker? h. Disoppear ond reappeor? fC/rc/e One for each question) Don't know Don't know Don't know 14 Did th9 object disappeor while you were wotching it? If so, how? 15. Did fhe abt^cr move behind something at any time, porticulafly a cloud? 16. Did the object move in front of something at any time, particularly a cloud? (Circle Cnm): in front of; _ IF you answered YES, then tell what experiment 19. Draw a picture mat will shew the shsoe of the object or objects. Label ortd include in your sketch ony details of the object 4*01 you sow such cs wings, protrusions, etc., and especially exhaust trails or vapor trails. place on ar*ow beside the drawing to show the direction the object wos moving.