PROJECT lC173 ~ECORD 1 1. OA"if= T aME Gi\:OUP CiY:.l ia.n t. N:ft~SER OF OoJECTS TI\SUFFICIE11' DATA FOR EVALUATlO;~ S. LEt'-IGT;; o:= OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS : : i . 1 'I'?!:: .JF D o SER VA TION Object flashed on and off every tv;o Si3Conds. Color: Object went out of sight behind s on:.c tree s that .-:a:c !'ront of observer. DK~AitTMIINT 0,. THE AUt ,.ORCK HIIADQUA.TII .. PO.IIION TIICMNOLOOY DIVI810N CAPeC W.IOMT~A1TII.80N AI. POIICII 8MII. OHIO 41841al UFO Obervation Re:t'erenee )'(-ur nn14eDtit1e4 O'bHrvation. '!be information vhlcb ve have received is not suttlcleat tor a scientific eva~atlon. Request you lete the attachecl P'tD 164 and return it ill the envelope provided. Tbaak you tor reporting your o'bHrvation to the Air Foree. S C. MANA'rl', Colonel, USAP 'DJ)~ctor ot 'l'eehnology and ~byteu FTD For 164 v/eravelope DI!~AitTMaNT 0,. THI! AI" ,.O .. CI! HEADQUA.TI... POHION TICHNO&.OGY DIYIIION I A"K t WRIGM'f~A I I I IliON Alii POIICI 8Aal. OHIO aa UFO Observation Hartford, Wisconsin Reference Y'tUr unideDtitie4 obaervation. 'lbe infonnatioo wtcb we have received is not sutt1c1ent tor a scientific evaluation. Request you coatplete the attachefl 1''1'0 Form 164 and return 1 t in the envelope provided. 'l'haak you tor reporting your obHrvation to the Air Foree. JAMES C. MANA'l'l', Colonel, USAF Director or Technology and 9ubayatema FTD Fol"'l 164 v /envelope U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you have observed. Please try to answer as many questions os you possibly con. The information that you give will be used for research purposes. Your name will not be used in connection with any statements, conclusions, or publications without your permission. We request this personal i,formation so that if it is necessary, we may contact you for further details. 1. When did you see the object? 2. Tirne of day: _jO ,'_Q9;.._ Hour Minutes (Circle One): 3. Time Zone: (Circle One': a. tastern f b; Central c. Mountain d. Pacific 4. Where were you when you Maw the object? City M Town Stote ot County 5. how long was object in sight? (Total Duration) Minutes Seconclt a. Certain c. Not very sure b. Fairly certain 5.1 How w~s tim. in sight deteu mined? ------------...;"~---- 5.2 Was object in sight continuously? Yes No /"- d. J~s,t.a guess 6. What wo!l the condition of the sky? 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked ot the object? (Circle Onej: a . In front of you b. In baclc of you c. To your ridtt d. To your left e. Overheod f. Don't remember FTO OCT 62 164 Thl farM -r .. dn F'm 164, Jul 61, which I obolete. d. IF you saYf the object at NIGHT, what did you notice concerning the 5 TARS ond MOON? 8.1 STAR~ (Circle One): o Don't remember 8.2 MOON ( (ire le One): o. Bright moonlight d. Don't remember 9. What were the weather conditions at the time you sow the object? CLOUDS (Circle One): c. Scattered clouds d. Thick heavy clouds HEATHER (Circle One): b. Fog, mist, or I ight rain c. Moderate or heavy rain . e. Don't remember @ The object appeared: (Circle One): d. As a light b. Transparent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): (_a B .Jer.-c. About the some 6. Dimmer d. Don't know 12. The edges of th obiect were: (Circle One): a . Fuzzy or blurred e. b. Like a briyht star Sharply out I ined Don t remember 13. D id the object: (Circle One for each qu.,stion) a. Appear to stand still at any time? Yes Don't know b. Suddenly speed up and rush away at any t ime? Yes Don't know c. Break up into ports or explode? Don't know d. Give off smolce? Don't know e. Change bri~tness? Yes Don't know f. Change shape? Don't know ... g. !=bs~l or fticlte~? Yes Don't know C h. GisopJ.'~ar a nd ;ec.pFearV Don't know Did th,...,.,.ect elisa ~hi le you were wotch ing it? If so, how? 15. Did th objttct motte t.hincl something ot any time, particull"rly o cloud? 16. Did the obi-ct mew in front of something ot ony tirntt, particularly a cloud? (Circle One}: Yes GJ Don't Know. IF you ons-.reci YES, then tell what 17. Tell in a few words the following things about the object: 18. We wish to know the an~ular siztt. Hold a match stick at arm's length in line with a known obiect and note how much of the object is coviH'eci bv the head of the match. If you had performed this experiment at the time of the sighting, how much of th object wnu!d hove been covered by the match head? 19. Draw a pictuN that will show the shape of the object or objects. Label and include in your sketch any details of the obi.ct that you saw such as wings, protrusions, etc., ancl esp.-cially exhaust trails or vapor trails. Place an arrow beside the drawing to show the direction the object was moving. . 20. Do you thinlc you can estimate the sp .. d of the obiect? (Circle One} IF you answered YES, then what speed would you estimate? j/ ~/{ Q. J?: ., 0 ,_ J Do you thinlc you can estimote how far away from you the obiect was? (Circle One) I.F you answered YES, thet~ how far away would you say it was? -------- 22. Where were you located when you saw the object? (C irde One): 23. Were you (Circle One} a. Inside a building b. In a car d. In 'an airplane (type) a. In the business section of a city? b. In the residential sec.tion of a city? c. In open countryside? d. Neor an airfield? e. Flying over a city? f. Flying Oer open country? r:' 2~. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the f.ollowing questions: 24.1 What direction wer you mOing? (Circle One) e. SoJtn g. West b. Northeast d. SauthflJst f. Southwest h. Northwest 24.2 How fast w.re you moYing? ,miles per hour. 24.3 o;d you stop ot ony titM while you .,,.. looking ot the object? (Circle Otte) Did you obser the ob;ect through any of the following? Eyeglass Binoculars Yes No b. Sun glasses f. Telescot:~e Yes Windshield Theodolite Yes d. Window glass In order that you can give as clear a picture as possible of what you saw, describe in your own words a common obiect or obiects which, when placed up In the slcy, would give the same appearance as the obiect which you saw; In the following alcetch, imagine that you ore at the point shown. Place ott "A" on the curveclline to show how high the obiect was above the horizon (skyline) when you first sow it. Place a a" on the some curved line to show how high the oliect was abooie the horizon (skyline) when you lost sow it. Place on ,.A,. on the compass when you lint sow it. Place a "B" on the compass where you lost saw the object 28. Draw a picture thot will show the motion that the object or objects made. Place on .. A" at the.beginning of the p~th, a .. B" 0. the encf of the path, and show any changes in direc:tio~ during thw course. 29. IF there was MORE THAN ONE object, then how many were there? ---------- Draw o pic:1'ure of now they were arranged, anJ put on arrow to show the direction that they were troveling. 30. Have you ever seen this, or a similar obiect b.fore. If ao give date or dot ond location 31. Waa anyone else with you at the time you saw the object? (Circle One) 31.1 IF you anawerecJ YES, did they IH the obiect toa? (Circle One) 31.2 PleaM list their names and addresses: 32. Please give the following information about yourself: TELEPHONE NUMBE AGE ./ ft SEX 33. When and to whom did you report thai you had uen the object? Month Year Zon. State 34. Date you co,.l,.td thia queatiannaire: . JQ_ ... 35. Information which yeu fl prtinent and which ia not adequately covr~ in the apcific polnta of the queatlartnaire or Cl ve explanation of your a ighting