1. DATE TIME C?.OUP Ci.rlliar. 4. NUMBER OF CoJECTS 2. LOCATION 10. CONCLUSION ~ Sat.ellito V ~ cf. cfJ...C) rr.. S. LENGTH OF 03SERVATION 11. BRIEF SUMMARY AND ANALYSIS 10 minut~s 6. TYPE OF OBSERVATION 8. PHOT OS 9. PHYSICAL EVlC~NCE FTD sep 63 0~329 (TOE) Obj~ct moved from the west to the east. The brightness appeared to be between a star and a planet. There is nothing in the report that does not indicate that the sighting is not a satellite. p,.vloua clition of thll form my b ued U.S. AIR fORCE TECHNICAL IHFORMATIOtf This quetlonnaire has been prepared so that you can give the U.S. A'r Force as muc~ information as possible concerning the unidentified aerial phenomenon that you hove olaerveti, Please try to answer os many questions as you possibly can. The information that you give will be us.d for research purposes, Your name will not be used In connection With any st~tement;;, cone I u.s Ions, or publications without your permission. We request this personal Information so that if if is deemed necessary, we mar contact you for further details. 1. When did yo~o~ see the obiect? (Circle OneJ: .-A.M.-or--p;M, 3. Time Zone: (Circle One}:( a. e.ostam.--: D. Central c. Mountain d. Poe ifl c (Circle One): a!~ Doy.llght So\'ing .C. Where were yo-J when you sow the objct? Hour a Minute a Second a a. Cenoln c. Not very sure c frly--ce-r!ofn_-:.-,. . d. Just a guess How was :ime ln sight determln.d? ....; 5.2 Was object in 1i~t continuously? 6. Whot waa the condit ion of the sky? 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked ot the obiect? (Circle One): a. In front of you In back of ~ou c. To your riW1.t d. To your left e. Overhead f. Don't remen1ber FTO OCT 62 164 Thle form eupereedu PTO 164, Jul 61, which Ia obaolete, 8. IF you aaw the obiect at NIGHT, what clld you notice concemlng the STARS ancl MOON? 8.1 STARS (Circle One}: 8.2 MOON (Circle One): BriW.t moonlight b Dull moonlight No moonlight -pitch dk cl. Don't remember d Don't remember 9. What WN the weathH ccnclitlons at the tlf!le you aaw the obiect? CLOUDS (Circle One): c. Scatter.d clouds d. Thiele or neavy clouda WEATHER (Circle One}: b. Fog, mlat, or light rain c. Moderate or heavy rain Don't remember 10. The obJeet op~ared: (Circle One): T ranaporent ~ t._. At a light_,; ~. Ocn't remember 11 . If It oppearo aa a light, was It bti;hter tnan the brlghteat atars? (Circle One}: a. Brl ;hter c. About the aame d. Don't lcnow 11.1 Compon bri;htneaa to some c~mon obJect: 12. The edgea of m obiect were: (Circle O,.j: Fuzzy ew blurr.cl 1>. (I lei a br fSi'..! rtcW:: Sharply outllMCI Don't rern.mb.r Did th oblec:t: (Circle One for each question) to stoncl atlll at any time? Don't lcnow Suddenly ap..d up and rush OWflll at any time? Don't lcnow Brealc up Into porta w explode? Don't know Give off &mole' Don't lcnow Change bri~tneaa? Don't lcnow Change ahaP"? Don't lcnow Flash or fllclcer? Don't lcnow Dlaoppear and reappear? Don't know 14. Dlcl the object disappe~ while you were watching it? If so, how? 15 . Did the object move behind something at any time, particularly a cloud? Don't Know. IF you answerecf YES, then tell what (Circle One): Yes 16. Old tho object move In front of ft~methinG ot any time, particularly a cloud? (Circle Onel: Yes ' _.N_o.l Don't Know. IF you answered YES, th~. t"H what 17 . Tell in a fe w words the following thin gs a bout the ob.ject: We wish to k f'IOW the angular size. H~ld a match stick ot arms length in line with a known ()bio:t on~ Oil'-:' "O'H much of the object is covered by the head of the roatch. If you had performed this experiment at the, ti r,....,J of the slghtini, how much of the ob;ect wou1d have been covered by the match head? 19. Draw a p icture fhot will show the shape of the object or oi)jects. Label and Include In your sketch any detalla of the object t he t you saw -1uch as wings, protrusion a, tc., and especially exha.ust trolls ar vapor trails. Place an crrow beside the drawing to show the direction the obieet was moving 20. Do you think you can estimate the speed of the object? (Circla One) Yes (~ IF you answered YES, then what speed would you ostirr,ote'~ -------- .Do you thi nk yotJ can estimate how far away from you the object Wfl$? (C ir: ie One) e \ No , IF you cn,wered YES, then how far away would you say it was? to_s2 "_\._1.. _ 22. Where were fou located when you saw the object? (C ire le One ): o. Insi de o btJilding b. In a cor d. In on o iplane (type) 23 . Wer~ yotJ (Citclc One ) a. in the bu:iiness section of o city? '-- lr h~ ros ident'El s'!~tic.u vc ~ity? c. In o plln country~ Ide? d. N"ar a n airfield? e. Flying over a city? f. Fly ;ng ofer open country? 24. IF you ""'~'~ MOVING IN AN AUTOMOBILE or other vehicle at the tim:e, then complete tho foHowh,9 queationa: 24.1 Wnct C:irection were you moving? (Circle One) c. Eost e. South b. NOftheost d. Southeast f. Southwe&t How fost were you moving? miles per hour. Did you stop ot any time whil e you wera looking at the obfect? (Cir: le One} Yes No h. Northwest Old you observe the oblect throu~h a ny of the following? Eye; losses Binoculars b. Sun ~losses Winc!sn i l d Yes ~; g. Theodolite Yes d. Windo~ '3!a u Yes In order that you can give os clear a p icture os possible of what yotJ :saw, describe in your own words o comrr.oo ~ object or objecta which, when placed up In tho sky, would give tho sarne appearance at the object which )ou scw1 27. In the following alcetch, fmagin. that you ore at the point ahown. Place an .. A'' on the curv.a lfn. to show how high the obiect was above the horizon (skyline) when you llrst sow it. Place a "B" on the tame curved line to show how high the obiect woa above the horizon (altyllne) when you lost flOW lt. Place an "A on the compaaa when you llrs t saw it. Place a "8., on the compass where you lost sow the object. 28 . Draw a pieture that will show the mot ion that the. oblect or obfects made. P.loee an "A r crt the beginning of the path, a "S" at the end of the path, end show any change: in direction during the course. 29. IF there wos MORE THAN ONE obj.ct, then how many were there? ---. _... _ Drew a picture of how they were arranged, and put on arrow to show the direction that thoy were traveling. 30. Have you ever seen this, or a similar object before. If so ~ive dote or dates and location. 31. Was anyone lse with you at the time you saw the obier;t? (Circle One) 31.1 IF you :lnSwerod YES, did they see the object too? ( Circlo One) 31.2 Please list their names and addreues: 32. Pleon gi ve the following information about youraolf: TE L E PHON~ NUMBER Indicate any additional Information cbout yourself, including a'ny spt~cial exporienc, which nlight b" ;'~rtitl~rn. When and to whom d id you report that you had seen the object? Day Month Year 34. Date you completed this questionnaire: 35. Information which you feel pertinent Gnd which is not adequately covered In the specific points of the questionnaire or a n01rative explanation of your sighting.