U.S. AIR FORCE TECHNICAL IHFORMATIOfi Thia quutionnaire has been prepared so thot you con ylve the U.S. Air Force oa much information as pouible concerning the unidentified aerial phenomenon that you hnvu oLserveti, Please try to answer as many questions as you possibly can. The Information that yc.:u g ive will be uaed few research purposes. Your name will not be used in connection with ony st()terr .. nf~, conc:lusions, or publications without yout perrnission. We request this personal lnforrMtion se that if It is deemed neceuary, we may contact you for further details, 1. When did you '" the object? 1. fim~ of rlo1 3. Time Zone: (Circle One): q: Eosterr c. Moontain d. Poe iflc 4. Where were you when you sow the object? (C1rc/e One): A.M. or (P.My (Cirda v ne): City or Town ~Ns fL.:ultlY. A.. . Srota '!II' Co''"'t 5. How long wen obJect in sight? (Tohll Duration) a , Certain c. Not very sure d. Just o guess Q,. Fairly certain J 5.1 How was t ime In sight determined? ------------------- 5.2 Was object In sight continuously? 6. What was the condition of the a&cy? 7. IF you aaw the object during DAYLIGHT, where was the SUN located os you look~d at the object? (Circle Orne): a, In front of you t,, In boc&c of you c. To 'f04N ri~t d. To your left e. Overhecd f. Don't r~member FTO OCT 62 16.C Thla ICIPM a!otpere.dea Jl'Tn 164, Jul 61, w"lch Ia obolt. 8. IF you sow tho obtect ol NIGHT, what did you notice concerning the STARS and MO~? 8.1 Sl AR~ (C trcle One): 8 . 2 MOON (Circle One): a . Bri~t moonlight b. Dull moonli t ( c . No moonli~t -pitch dark:) d. Don't rememoet d. Don"t ,.,."'bet 9. What ..... ,. tne weather condttions at the time you saw the objKt? CLOUDSf;C~rcle One}: (0; Sle nr s1CV WEATHER (Circle One}: b. Fog, mist, oc lr~t ralu c . Scatte~ .. d cl()uJs c . Moderate or heavy rain d. Thrd 0 4 heu~y ci~>Ud d. Snow . Don t remember 10. The object appeared: (Circle One). ( o . Solrci d. Aa o light b . r rtlflltlm .... e. Don't remef91bet 11. If it appeared 01 0 light, WQI it br ighter man the brightest stars? (Circle One): o . Brighter ~rR ~bout ~.e son:-~, d. Oon"t ~now 12. The edge of r+le object were: ((,,do'' " " ) a. fuzzy~ blurred b. Lilce a btlyht atar ~orply out(fr!ed) on"t re,.mber 13. Did "'- obtect: Ap~or t o stond still Of O"'f t i,.,.? Suddenly speed up oncl ruah away at any time?. Brea~ up into parte ot explode? Gtve off amolce? Change btis#1tneaa? ange shape? flash oc flicller? 0 r4appeor and reoppeor? (Circle One for each queetlon) DOt\'t lcnow (No) Dan"t lcnow Don't know Don"t lcnow Don't know Don't know DM't !tnow 14. Did the object disappear while you were .. ,etching it? If so, how? 15. Did the object move behind somethrng at any time, partic ui..Jrly a cloud'? (Circle One): Don't Know. IF y ou .:mswered YES, lhttn tctll what it moved behind: 16. Did the objed move in front of Gl)mething at any trme, porticularly a cloud? (Circle One): Yos Don't Kno w. IF you answered YES, th~ ,.,11 wit 17 . Tell in o few wOfds the following things about the object: o, Sound _ ,_T'r:IGR.E W.A~.fl.s:L~.Jt:J. D A~ IJ:I ~. 18. We wish to know the angular sixe. Hold a match stick at arm' :~ length in line with o kno wn ubject one ~":l '".nr much of the nbject is covered by tho head of the match, If you hod perfOfmed this experiment a t tht~ tir.,..; ._.i Le sighting, h o .., rnuch of the object would hove been covered by the match head? 19. Draw o picture that will ahow the shope of the object or objects. Lobel ond include in your sketch any detoi l of the object that you saw .. uch aa wings, protrusions, etc., ond especially exhaust trails or "'apor traila Place on arrow beside the drawing to show the direction the object was moving. 20. Do you think yo u can estimate the speed of the object? (C ire /e One) IF you answered YES, then what speed would you estirr.ate~ 21. Do you think you can estimate how far away from you the object was? (Circle On~) cf!j) No IF you answered YES, then how for away would you say it was? -.JaQ_Q hI 22. Where were you located wh.n 'IOU aaw the object? (Circle One): . . . o, Inside a building b. In a car (C: OutdoorV d. In on airplane {type) e . At sea 23. Were yo\1 (Circ/o One) In the business section of o city? lr. rl-:~ residential S\tc ticll "'a city?) cm country~ide? N"ar an a irfield? Fl)'ing over a city? Fly;n~ ov er o pen country'! 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete t~e foHowir.g queationa: 24.1 What dir<!!ction w.,. you lnOVing? (Cirefe One) a. North c. East e. South b. Northeast d. Southeast f. Southwest 24.2 How foat wer8 you moving? miles per hour 24.3 Oicl you atop at any time while yOtJ were looking at the object? h. Northwest 25. Old you observe the object through any of the following? o. Eyeglaun Yea Binoculars Yes No b. Sun glauea Yes f. Telescope Windshield g. Theodolite d. Window glau h. Other ~ t-~ 6:.tfT' 26. In order thot you can give aa clear o picture aa possible of whot you s o w, describe in your own wordt o comm~ object or objects which, when placed up in the alcy, would give the some appearance aa the object which ) 'OU ao- 27. In the followlnt alcetch, lmoglne that you are at the point hown. Place un "J.. .. on ~he r.urv~ line. to ahow hov. h igh the obJect waa above the horizon (akyllne) when y<AJ llrJt aow lt. F'lac8" "B'' on the a.:Jme cur.,ed line'<' ahow how hlih the object was above the horizon (skyline) when you last !Saw it. Place ~n "A'' on the compou l when you llr~t aaw lt. Ploce o "B" on the compn where you lfut aaw t h ohject. I 28 . Draw o picture that will ahow the motion that the object or objects mado. Place an "A' ' at rhe begiMI:19 ot rhe path, : .. S .. ~ the end of the perth, and thow ony changes in direction during the -:ouue, IF there woa MORE THAN ONE obJect, then how many wet there? 0 1.,/f:T ObI ee-7 - Draw a picture of h'" they Wete onanied, and put an arrow to ahow the dirction that they were travuling. 30. Hv ~.,ever 1-.n thia, or a aimilar object before. If ao give date or dote and locotl~ 31. Woa anyone ol1o with you at time you 1aw the object? (Circ:le One) 31.1 IF you anawerecj YES, did they IN tho object too? (Circle One) 31.2 PI Uat their namoa end oddrouoa: 32. PIHto glwe tho followlnt lnfmotlon about yout~olf: tmllcoN "Y ..WftleftDI lnforntiOft about younelf, lnclucUnt any apoclal experience, which Jftight be p~rtln.nt. 33. When a,_. tow+..,.. did you reJJrt thot you had'"" tho object? 34. Date you completed this questionnaire: 35. lnfcwiMtlon which you fHI pertiMnt and which Is nat adequately covered In the specific polntl of the , , queatlonnalre cw a narrative explanation of yow sighting. l't i i"I.Y TO DEPARTMENT OF THE AIR FORCE HEADQUARTERS FOREIGN T ECHNOL.OGY DIVISION I APSC) WRIGHT.,.ATTERSON AUt I"ORCE IIASIE. O H I O 45433 30 Jamary 1967 UFO Observation., 12 Jul. 66 Refer ence your unidentified observati on. The informati on wh ich we have received is not sufficient for a scientific evaluation. Request you complete the attached FTD Form 164 and return it in the envelope provided. Thank you for reporting your observation to the Air Force. MANA'IT, Colonel, USAF of Technology Hnd Subsystems F'l'D Form 164 w/envelope