31/0l05Z Chel tcr..ho.m, Pa . SOl.J~C:! 10. CONCLUSION ~ Grot:.r.d Vis~l Aircraft V o:: cbjcct~ U.S. AIR FORCE TECHNICAL INFORMATION T hi s questionnaire has been prepared so that y.ou can give the U.S. Air Force as much inform:tion as possible concerning the unidentified aerial phenomenon that you have observed. Ple:2se ~ry to answer as many questions as you possibly can. The information that you give will be use:3 for research purposes. Your name will not be used in connection with any statements, conclu s ions, 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 yo~ see the obiect? 2. Time of day: 3. Time Zon~: (Circle One): (~:) t:astern ~. Cent:-ol c. Mour.t= il"\ d. Pacific (Circle One): (Circle One): ~."Daylight Saving b. Standard 4. Where were y ou when you saw the o b ject? Necrst Posta 5. How long w~s object in sight? (Tete! Duration) :. Certoin b. Fairly certain City or Town (_C;~ Not very sure d. Just a guess Stot or Ccaunty 5.2 Was obiec~ iil s ight continuously? 6. What was the c:~nd it ion of the sky? & Cloudy .J P,;?r-1 f,.; 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the obiect? I~/ (Circle One): a. In front of you b. In back of you c. To your right d. To your left e. Overhead f. Don't remember FTO OCT 62 164 Thla form auperaed .. FTO 164, jul 61, which ia obaolete. 8. IF you saw the obiect at NIGHT, what did you notice concerning the STARS and MOON? 8.1 STARS (Circle One J: @ Don't remember 8.2 MOON (Circle One}: a. Bright moon I ight (b." Dull moonlight c. No moonlight -pitch dark d. Don't remember . 9. What were t ne weather conditions at the time you saw the obiect? CLOUDS (Circle One): WEATHER (Circle One): a. Clear s ky b. Fog, mist, or light rain <.~ Scatter~:l c: louds c. Moderate or heavy rain d. Thick or heavy clouds e. Don't remember 10. The object a ppeared: (Circle One}: (~/As a light b. Trcnsp.::~e'1t e. Dor. t remember 11. If it ::ppe~red os a light, was it brig~te:-t han the brightest stars? (Circle One): a. Brig~ter b. D im:ner c. About the same @Don't know 11.1 Comp:lre ~rightness to some common obiect: The edges of tne object were: (Circle O ne ): o. Fuzzy or bl urred e. b. L ike a br i yh t s t or Sharply out I ined Don't remember Did the object: (Circle One for each question) Appear t o s tand still at any time? Don't know Suddenly s peed up and rush away at any time? Don't know Break u p in~o ports or explode? Don't know Give off s~o~e? Yes Don't know Change brightness? Change shape? Don't know Flash or flicker? Don't know Disappear and reappear? Don't know 14. Did the object disappear while you were watching it? If so, how? 15. Did the obj e'=t move behind something at any time, particularly a cloud? (Circle Or.e): Don't Know. IF you answered YES, then tell what it mov~d behind: _ 16. Did the obiect move in front of something at any time, particularly a cloud? (Circ le One): Yes Don't Know. IF you answered YES, then tell what in a f'!w words the following things about the object: 18. We w is h to ~now the angular s ize. Hold a match stick ot arm's length in line with a known object and note how much of the object is covered by tn~ need of the match. If you hod performed this experiment at the time of the sighting, how much of the object wouJd have been covered by the match head? 19. Drew c ;:>ic~:..!i~ th::t wi II show the sh~pe of the object or objects. Label and include in your sketch any detoi Is of the obj~c+ t~ct y ou saw such os wings, protrusions, etc., and especially exhaust trails or vapor trails. Place on a:-r~w Ses ide the drawing to show the direction the obiect was moving. 20. Do you think you con estimate the speed of the object? (C ire le One) Yes ~ IF you answere d YES, then what speed would you estimate?------------ 21. Do you thin~ y ou can estimate how for away from you the object was? IF you onsw~red YES, then how far away would you say it was? ------------ 22. Where were y ou located when you sow the object? (Circle One 1: a. Inside o building b. In a car @1 Outdoors d. In on oir~lane (type) 23. Were you (Circle One) a. In the business section of a city? @ In the residential section of a city? c. In open countryside? d. Near an airfield? e. Flying over a city? f. Flying over open country? IF y~u were Y.OVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 24.1 What :l.rection were you mov in;? (Circle One) o. Nor~ c. Ecst e. South b. Nort heast d. Southeast f. Southwest h. Northwest 24.2 How f:::st were you moving? miles per hour. 24.3 Did y~u sto p at any time while you were looking at the object? (C ir: le One) Did y ou obs erv~ object thro u gh or1 the following? Binoculars Eyegbs s~s Yes I No Sun gbsses Windsh:~I: g. Theodolite Yes No' Window g lo ss 26. In order that y':J'J can give as clear a picture as possible of what you sow, describe in your own words a common object or object s which, when placed up in the sky, would g ive the some appearance as the object which you saw. 27. In the following sketch, imagine that you ore at the point shown. Place on "A" on the curved line to show how high the object was above the horizon (skyline) when you first sow it. Place o "8" on the some curved line to show how high the obiect was above the horizon (skyline) when you lost sow it. Place an "A" on the compass when you first sow it. Place o "B" on the compass where you lost sow the obiect. i 28. Orow o picture that will show the motion that the obiect or obiects mode. Place on "A" at the beginning of the pctn, o .. B ' ' o~ the end of the path, o~d s!tu~ ~ny changes in direction during the course. IF there w:~s MORE THAN ONE object, then how many were there? -/AI'ee It e;ft/s Draw a picrur~ of how they were orronged, and put an arrow to show the direction that they were traveling. 30. Have you ever seen this, or a simi lor obiect before. If so give date or dates and location. 31. Was anyone else with you at the time you saw the obiect? (Circle One) 31.1 IF y ou answered YES, did they see the obiect too? (Circle One) 31.2 Ple~se list their names and addresses: 32. Pleose give the following information a bout yourself: Middle Nome TELEPHO~= NUMBE Indicate ony oddit ional information a bout yourself, including any special experience, which might be pertinent When and to wh:>~ did you report that you hod seen the object? 3~. Date you completed this questionnaire: Information which you feel pertinent and which is not odequat_ely covered in the specific points of the q~estionnair~ or a narrative explanation of your sighting.