PROJECT 10073 RECORD J 1. o7 n: TIME CROUP 4. NUMBER OF OBJECTS 2. LOCATION Poulsbo, \fashington 10. CONCLUSION In~ufficient Data T1, BRIEF SUMMARY AND ANALYSIS 5. LENGTH OF OB-SERVATION 8-10 Ninutes 6. TYPE OF OBSERVATION Ground Visual ~se'!'Ver not sure of dati}' and how many o~, ects there were. Object./s shot etrlaight up then dis< ppesr~d !.o the south. Also conib,iy.tUlg ~ata. To th~ South 9. PHYSICAL EVIDENCE FTD SEP 63 0-329 (TOE) p,..,to11 eclll0fta of thJa form m1 b4t ued. U.S. AIR FORCE TECi1NICAL INFORMATION This questionnaire has been prepor!d so tha t you con give the U.S. Air Force as much information as possible concerning the unidentif.ied oarial p tnomenon that.you ho"Je ob..sor.~ed. Pl~ose try to ~nswer as ~any que~tions as yo_u possib_ly can. The informotic:" 'that you give~will. be used for research purposos. Your no~ will not be used In conn.e~tion with ony stote~nts, conclusions, or publications without your permission. We request this personal informat ion so that if i~ is deemed necessary, we may contact you for further detai Is. 1. When did you see t~e object? 3. Time Zone: (Circle One): (Circle One): <!:.. Daylight Saving (~:.1 Standard (Circle One): a. tost~rn b. Central c:. Moi.H"J-::i n d. <Paciri0 4. Where were you when you saw the object? Nearest oatol Address City or Town Sta te or County 5. How l ong was object i n sight? (Total Duration} Hours Minutes Seconds a. Certain . c. Not very sure b. Fairly certain d. Just a gues\_ 1 5.2 Was obje~t in sight continuously ? Ye s ,..'( No _ 6. What was the cond ition of th~ sky? (?., Bright 6.' Cloudy 7 . IF you sow the object during DAYLIGHT, ~ere was the SUN located as y o u looked at th~ object? (Circle On~): a. In front of you b. In bl1ck of ycu c. T o your right d . To your left e. Overhead f. Don't remember ~. I F you sow the object at NIGHT, what did. you notice concerning tl1e STARS and MOON? STARS (C ircle One): d. Don't remember 8. 2 MOON ( C irde One): Bright moonlighr.' Dull rnoonlig~t N~ moonlight -pitc h dOTk Don't remember 9. What were rhe weather conditions ~t the time you saw the objec~? CL OUOS (Cirde One): (_a_;. Clear s k y c. ScaHered clouds d. Thick or heavy cf~.uds -NEATHER (Circle One): b. Fog, rnist , or light rain c. Moderat e or heavy rain e. Don't remember 10. The obj!:c t ~f'peored: . (Circle Qne): b. T ronspar~nt 0 i As a light e: Do.,t remember 11. If it oppenr~d as a light, was it bright~r than the brightest stars? (Circle One): a. Brighter c. About th~ some d. Don' t know 12. The edges of the objec t were: (Circle One); a . Fuzzy o r blurred b. Like o br iyh t star Sharply outlined Don't r~ mem b~r Did the object: One fo r each -1uestion) Appear to stnnd still CJt nny time? Yes Don't know Sud d~n ly spe ~d up and rush away at any ti me? Y-:!S . Don't know Break up in ~o parts or explode? '(-:!S Do11't know Give o ff smo~e? Don'r k n r w Change brtghtn~ss? Don' t know Change shape? ~ Don't know g. Flas h or fl icl<er? Don't know h. Disappear end reoopear? Yt!s -NO I Do n't !<now 15. Did the ob;ed move behind s omething ot any ttme, p articula rly a cloud? ( Circle 01"e): Yc~ Don't K11ow. IF you a n s wef.:!d YES, t hdn tell what it mo v,..d ~hind: 16. Did the obj"!ct mov~ in f ront of somethi ng at any time, particularly o cloud? Don't Know. IF y ou answered YES, then tell what (Circle One): in front o f: Tell in a few words the following thing s about the object: 18. Wa wish to know the angular size. Hold o match stick at arm's length in fine with a k no...,n object a nd not~ how much of the object is covered by the heori of the match. If you had performed this a;<peri,:nent at t h e t ime of the sighting, how muy. of the object would have been cover~td by ~he .match heed~ . ~: /'Z-;'1..-w ~-c',L...t..-._ 19. Draw a pictvre th~t wi II show the shape of the object or objech. Lobel and include in your ~ketch any detoi Is of tn~ object r;,-;:t yo u saw such as win;;s, prot:-t:Jsions, e~c., and especially e xhaust trails o r vapor trails . Place on orrcw beside th drawi ng to show the direction tlie object was moving. c-::,!.. .. ..;;; -. !...(. :~ ., _ . 20. Do Y?V thtnk you can estifT'nte the speed of thd olJ1ect ? "1--t.,u.-:f~h (.., . .tc.-<.-~ (~ ~ '-J:-: I F you onswerecit ES, then~ol s peed would you cstimote. ... -::.. :-_ - ~>-( Hhere were you located when 'you sow the obj'!ct? (Circle O ne I: o. Ins ide o cui I ding b. In a cor G~ Outdoors d. In on oir::done {type) 23. Were you (Circle One) o . In the business section of o city? h. In the residential section of a city? @In open countryside? d. N-,or on oirfiuld? e . Flying over a ciry? f. Flying over o;:>en country? 24. IF you (olere t.-IOVING IN AN AUTO.v.C21LE or other vehicle at the time, then campie r., th~ f o ll o win g questions: 24.1 What d 1rection were you moving? (Circle One) o. South g . West b. Northeast d. Southeast f. Southwest h . Nor~hwest 24.2 How fast were you moving? -------- i le~ per hour. 24.3 Did you stop ot any time while you were looking at th'! object? (Circ/-;, One} . 25. Did you observe the object through any of the following? Binoculars Eyoglosses Yes No b. Sun glos.ses Yes No f. T<Jiescope Yes No Th ~odolite Yes No Wind:;hi d Yes No g. Window g! ::ss Yes No . 26. In order rhot you con give o s clear o picture o:; po.;sible o f w!-lat you soH, describ,.. itl your own word:; o c ommct l ' o!:lj~ct or obj~':ts . ...,f-Jich, when oloced up in th~ sky, w otJ!d ~ive rhe S'lm~ OC'peoron(' 9 o:; Hl<! ,,bject v1:ch you .>l"'w.! b 1h" following sk!ttc h, imcgine that you o r.l!l at th'e point ~hown. P loco e n A ' ' en the cufv~d I in" t o ~how how high th e o b ject was a bov~ tlitt horizon ($ kyline ) when you first S:lW it. Plac e a ''B, o n the so~ cur1d line to show how h igh th& ob ject was above th& hori.~:on (:~kylin~t) when you lost saw it. Pluc~ a n 'A" en rh~ compou wh~n you first :>.Jw it. Ploce a " B " on th" compass whl!lo you lo.sf sow 1h~ obj.-,ct, 28. Orow a pictur~ tha t wi ll show the mot ion that the obj~ct o r object~ mod~. P loce o n "A"' a t the b.ginning o f th path, a "B H"; o t the end of,the ~.at~, and sl tuY. .:.oy change~. i n -~i re.ition d uring thl!l COJn<!. ,. - . .. . I r 29. IF tnre was MORE THAN ONE o b ject, then how mony were there? ----------- Draw a picture of how they were arranged, and put ~n arrow t o show th!t di rection th"t they were tro~Jing 30. Have yoJ .,ver s~en this, or a similar object befo~e. If s o give dute or du~es and location . ~l. Was anyon~ ~Is"' with you at the time y~u s a w the object?' (Circle.O~e) 31.1 IF y ou answered YES, d id they see the object t oo? ( Circle O n e ) 31.2 Pba.s~ I ist t names and addresses: 32. P.lease give th\'! following information obout yourself: TELEPHONE NUM 34. Dot_, you complehd this questionnaire: Day >.lonrh 35. Information w~i::l, 'fOU feel p~rtinent and which is not cdequotely covered in the specific point:s of tha qu~tionnaira <:>t 'J narrative explanation of yoiJr s ighting.