1. OAlF. 1'1ME GROUP 2. LOCATION 3. :;OIIIKE 10, CONCLUSION INSUFFICIENT DATA FOH EVALUATION .i. NliH~C R OF OBJECTS !i. LENGTH OF OBSERVATION 11, BRIEF SUMMARY ANO ANALYSIS SEE CASE FILE to. TYPE OF OBSERVATION Ground-Visual ?. PHYSICAL EVIOENCE r-TD SCP63 0-329 (TOE) PNvloue edlUon of lhl tom mey be uaed. 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 as you fitOssibly can. The information that you give will be used for research purposes. Your name will DOt be used in connection with any stotGments, conclusions, or publications without your permission. We request this personal information so that if it is dee!Md necessary, we may contact you for further details. 1. When did you see the object? Hour Minutes 1 (Circle One): (Circle One): a. Eastern b. Central 4. Where were you when you saw the object? 5. How long was oDjfl:t in sight? (Total D IH'otion) a. Certain CD vV''rl J c: Not very sure d. Just a guess 5.2 Was object in-sight continuously? Yes No ~ cb..:, Fa irly certaiiY 6. What was the condition of the sky? 7. IF you saw the object during DAYLIGHT, where was the SUN located as you lo oked at the object? (Circle One): o. In front of you b. In back of y~u c. To your r ight d. To your left e. Overhead f. Don't remember FTD OCT 6 2 164 Thle rorm eupereed .. FTD 164, Jul 61, which le obsolete you saw the object at NIGHT, what did you notice concerning the STARS and MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle One): a. Bright moonlight D~,~ll moonlisht No moonliaht -pitch dor~ Don't remember d. Don't remembe r What were the weather conditions at the time y01 saw the objec1? CLOUDS (Circle One): WEATHER (Circle One): b. Fog, mist, or light rain Scattered clouds c. ModMate or heavy rain Thiele or heavy clouds d. Snow Don't remember The object appeared: (Circle One): d. As o l ight) Transparent e. Don't remember If it appeared as a light, was it brighter than the brightest stars? (C ircle One): c. About the some b. Dimmer d. Don't know Compare brightnesa. to some common object: The ~ges of the object were: (Circle One): a. Fuzzy or blurred e. b. _1 ike a bright stor , .,ly out I if!!D Don't remember 13. Did the object: (Circle One for each question) Appear to stand still at any time? @ Don't know Suddenly speed up and rush away at any time? Don't know c. Break up into parts or explode? Don't know Give off smoke? Don't know e. Change brightness? Don't know Cha nge shape? Don't know Fla~h o r fl icker? Don't know Disappear and reappear? Don't know Did the object disappear while you we re watching it? If so, how? 15. Did the object mewe behind something at any time, particu la rl y a c loud? (Circle One): Don't Know. IF you answered YES, then tell what it mewed behind: Did the o b ject mewe in fron t of something a t any time, particularly a cloud? (Circle One): on't Know. IF you answered YES, the n tell what in front of: _ 17 . Toil in a few words the following things about the object: Cro-t...JZ( Ho ld o match s tick at arm's ;ength in .line with ~nown object and ::te how We w ish to know the a ng u lar size. much of the object is covered by the head of the match. If you had performed this experiment a t the t ime of the ghting, how much of the object would h<Mt been covered by the match head? 19 Draw o picture that will show the shape of th e object or objects. Lobel and include in your sketch any details of the object that you sow such as wings, protrusions, etc . , and especially exhaust trails or vapor tra ils. Picco en arrow besid. the drawing to sho w the direction the object was mewing. 20. Do you think you can estimate the speed of the object? (Circle One) IF you answered YES, then what speed would you estimate? 5D M.p. fl_ 21. Do you think you con estimate how far away from you the object was? ( Circle One) ' (Y!J) No IF you answered YES, then how for away would you say it was? _:..M-:l.:L=----- 23. Were you (Circle One) 22. Wh.,.e were you loc~ted when yw saw the _obj~ct? -(C irc/e One): a. In the business section of a city? a. Inside a building b. In the residential section of o city? b. In a cor ~In cipen countryside?) Outdoor~ d. Near on airfield? d. In an airplane (type) e. Flying over a city? e. At sea I' .. f. Flying over open country? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following question~: 24.1 What direction were you rnoing? (Circle One) a . Nor~ c. East e. South g. West b. Nor tlteost d. SoutheOS"t f. Southwest h. Northwest 24.2 How fast wer~ you movtng? ,mmiiles per hour 24.3 D id y ou stop at any time while you ...,..,e looking at the objec~? (Circle One) Did you obsMV~ ~ obr~t through any of the following? Eyeglasses Yes Binoculars Yes b. Sun glasses Yes Telescope ({> No c. Windshield Yes ,raJ g. Theodolite Yes @ Window gloss Yes h. Other " 26. In order that you can g ive as clear a picture a s possible of what you s ow, describe in y our own words a co mmon ect or objects which, when placed up in the sky, would give the same appearance as the object which you sow. 27. In the following sketch, imagine that you are at the point shown. Place an "A" on the curved line to show how the object was above the horizon {skyline) when you f irst saw it. Place a "B" on the same curved line t o show how high the object was above the horizon {skyline) when you last saw it. Place on "A" on the compass when you first saw it. Place a "B" on the compass where you last saw the object. Draw a picture that will show the motion that the object or objects made. Place on "A" at the beginning of t he path, a "B" at the end of the path, and show any changes in direction during the course. 29. IF there wos MORE THAN ONE object, then howmony were there?----------- Draw a picture of now they were arranged, and put an arrow to show the direction that they were traveling. 30. Have you ever seen this, or a simi lor 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) 31.1 IF you answered YES, did they see the object too? (Circle One) 31.2 Please l ist their names and addresses: 32. Please give the following information about yourself: Lost Nome First Nome Middle Home CD ~\..lC02 v VfLfb'2.C City LeN State T:=L EPHONE NUMBER_ lndic~te any a ddit iot'OI'infOtnrction about yourself, including any special experience, which might be pertinent 33. When and to whom did you report that you had seen the object? Month Year Month r Yeor - 34. Date you completed this questionnaire: 35. Information which you feel pertinent and which is not adequately covered in the specific points of the questionnaire oro narrative explanation of your sighting.