r:-DATE. T IME GROUP 3. :,OIH: CE Civil:L:>n 4. NlJMSER OF OBJECTS 5. LENGTH OF OBSERVATION 10 llinutos 6. TYPE OF OBSERVATION Ground - VisW. 8. PH OTOS 9. PHYSI CAL EVIDENC E PROJECT 10073 RECORD 2. LOCATION .:itnesses) 10. CONCLUSION Ponsible (AIRCRAFT) -{t~ tlGw vp fd :-ro data prcsent.t:' l to lmi.c:L~cd oi:.'j ect could lJCt h a v e ne~n 11. BRIEF SUMMARY AND ANALYSIS Observer s noted f)bjcct. t h.J.t a p}:'P-ared as 8: l i ght tha t Hent out and the object shot strni1.;ht up. A red light w:.s obserV!t:t t.h~ t appeared to ._-o ur a11d rlo\-m. \'lhtn object took off t here t-r; ... ~ :3. v ery l oud r oo r a~ ~..:l a J ~.:t U.S. AIR FORCE TECiiNICAL 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 hove observed. Please try to answer as many questions as you possibly con. The information that you give will be used for research purposes. Your nome will not be used in connection with any statements, conclusions, or publications without your permission. We request this personal information so that if it is deemed necessary, we may contact you for further details. 1. When did you see the object? 2. Time of day:---------~r..l..'?'~j._, 3. Time Zone: (Circle One): (O. t:ost,:!3) b. l .entrol c. Mountain d. Poe if ic e. Ot!-ter Hour Minutes (Circle One): (Circle One): a. Daylig!lt Saving (b.-Standard) 4. Where were you when you sow the object? City or {;'own Neat.vest oslal Address 5. How long was object in sight? {Total Ovtotion) Hours M inutes a. Certain . /, ,r'J yo.?'"_,~ c. Not very sure ~J Fairly certain t.c--- d. Just o gue$5 How was time in sight determined? U~ Rtn i 4J Uvlt.cvf 5.2 Was object in sight continuously? Yes~ 6. What was the conditi on of the sky? lo:") Bright State County 7. IF you sow the object during D AYLIGHT, where was the SUN located as you looked at the object? (Circle One): a. In front of you In bock of you c. To your right d. To your left f. Don't remember FTD OCT 62 164 Thla Corm aupeuedea FTn 164, Jul 61, which i s obs olete. 8. IF you saw the object at NIGHT, what did you notice concerning the STARS a nd MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle One): a . Bright moonlight b. Dul l moon I ight @).Don't remember C : No moonlight-pitch dar k @ Don' t remember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): WEATHER (Circle One): Fog, mist, or light rain c. Scattered clouds c. Moderate or heavy ra in Thick or heavy clouds d. 10. The object appeared: b. T ransporent (Circle One): ~As a light e . Don't remember Don' t remember 11. If it appeared as d light, wa s it brighter than the brightest stars? (Circle One): )"ll'-'J,/ (~ Br ightP.r c. About the some b. Dimmer d. Don't know Comparft brightness to some c.ornmon object : 12. The edges of the object were: (Circle One): a. F uzzy or blurred Like a briyht star c . Sharply outlined Don't remember Did the object : a. Appear to stand still at any time? b. Suddenly speed up and rush away at any time? c. Break up in to parts or explode? d. Give off smoke? e. Change brightness? f. Chang"' shape? g. Flash or flicker? h. Disappear and reappear? (Circle One for eoch question} Don't know Don't know Don't know Don't know Don't know Do n ' t know Don't know 15. Did the object move behind something at any t ime, particularly a cloud? (Circle One): it moved behind: Don't Know. IF you answered YES, then tell what 16. Did the object move in front of something at any time, particularly a cloud? Don't Know. IF you answered YES, then tell what 18. We wish t o know the angular size. Hold o match stick at arm's length in line with a known object and note how much of the obiect is covered by the head of the match. If you had performed this experi,ment at th~ time of the. sighting, how much of the obje~t would have be~n c9vered by the match head? fun-t,(. h ~u! -lf.ra.e( 19. Draw a picture that will show the shape of the object or objects. Label and include in your sketch any details of the object that you sow such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place an arrow beside the drawing to show the direction the object was moving. 20. Do you think you con estimate the speed of the object ? f. ty~U ~ IF you answered YES, then what speed w uld you estimate? f\Jv.A\.. 21. Do you think you con estimate how for away from you the object was? . ; ~ ,.. (Circle One) G No 0 + c .f-f o ~ IF you answered YES, then how for away would you soy it wos?i l ...d- t. .f\.Ll:{- 22. Where were you located when you sow the object? (Circle One): 23. Were you (Circle One) a . In the business section of a city? a. Inside a building b. In the residential section of o city? Q In open countryside? d. Near on oirfie ld? G) In o cor c. 011tdoors d. In on airplane (type) e. Flying over a city? f. Flying over open country? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 24.1 What direction were ) 'OU moving? (Circle One) e. South (j) West -;t~Lil f. Southwest h. Northwest ~ b. Northeast d. Southeast 24.2 How fast were you moving? _QIJ....: 24.3 Did you s top a t ony t ime wnile you were looking at the object ? (Circle One) ~ No 25. Did you observe the object through any of the following? a. Eyeglasses b. Sun glosses c. Windshield e. Binoculars Yes @ f. Telescope Yes C2. No g. Theodolite Yes & d. Window glass Yes 26. In order that you con give as clear a picture as possible of what you sow, describe in your own words a common n object Or objects which, when ploced Up i1 the sky, would give the some appearance OS the objectp ch you SOW, Lf -vi'vt a. . ~ 27. In the following sketch, imagine that you are at the point shown. Place on "A" on the curved I ine to show how high the object was above the horizon (skyl ine) when you first saw it. Place a "B" on the same curved l ine to show how high t he object was above the horizon (skyline ) when you lost sow it. Place an "A" on the compass when you f irst saw it. Place a "B" on the compass where you last saw the object. 28. Draw o picture that will show the motion that the object or ~jects made. Place on "A" at the beginning of the path, a "B '' at the end of the path, and shu-.. .1ny changes in direction during the course IF there was MORE THAN ONE object, then how many were there? <.~ ftwLj~ Draw a picture of how they were arranged, and put an arrow to show the direc!Jion that they were troveling.jr~ 30. Have you ever seen this, or a similar object before. If so give date or dates and location. 31. Was anyone else with you at the time you saw the object? (Circle One) No 31.1 IF you answered YES, did they see the object too? (Circle One) 31.2 Please list their names and odd 32. Please give the following information obout yourself: First Nome I ADDRESS _ .! TELEPHONE NUMBER Indicate an additicmol information about yourself, including any special experience, which might be pertinent. ServtJ JD 'fl!().VS il\ -fhc. !J,r Force j:vt5t rc.s.JheJ 33. When and to whom did you report that you hod seen the object? Day Month Yea r Ff:j~+ Tej{h; 34. Date yoy completed this questionnoiret: