~ROJECT lOOi'J RECOf(O 1. OA 1 F. TlME GRO'uP 2. LOCATION ( 1 wi t.ne~u) lawn, Illinois 10. CONCLUSION 3. ~iOtH~CE Civilian \ .i. Nll arR OF 08JECiS ~;. LENGTH OF OaSERVATION 10 seconds 1 TYPE OF OBSE:RVATION Ground.-Vis..:~:. -:. COURSE ~. PtiOTOS ..,f9. PHYSICAL EVi:>ENCE INSUF'F'ICIENT DATA FOR EVALmATION 11. BRIEF SUMMARY AND ANALYSIS was whi tc and changed to Rdd but appeared to be ro~r.~ ~ made abrupt movements. f-TD Sf P 6 3 0329 (TOE) Prevloua editJOft 'of thla foliA 1 be uecl. U.S. AIR FORCE TECHNICAL INFORMATION This ~uestionnoire has been prepared so that you can give the U.S. Air Force os much informotio, as possible concerning the unidentified aerial .Phenomenon that you have observed Please try to answer os many questions as you possibly can. The information that you give will be used t':)r raseareh purposes. Your nan will not be used in connection with any statements, ccnclusions, or publications without your permission. We request this personal information so that if it is deemed necessary, we moy contact you for further details. 1. When did you see the obiect? 2. Time of day: --'R-~-:~il -Z;J.;Jo .. (Circle One): 3. Time Zone: ( C ircle One): a. tJutern Q:'"-Centror; c. Mountoin d. Pacific 4. Wner~ were you when you sow the object? ity or Town State or County 5. how long wos ob ject in sight? (Toto ! D~rotion) Hours Minutes c. Not very sure d. Just a gu 5.1 How was t :ne :n s i;ht determil.,ed?-"' ~ .... ~w.J 5.2 Was object :n ~'~t :ontinuously? 6. What was the co~d:~::n :)f the sky? a. S ri ; ht b. C loudy 7. IF you saw the ebject during DAYLIGHT, where was the SUN located as you looked at the object? (Circle One): a. In front of you b. In boclc of you c. To your right d. To your left e. Overhead f. Don't remember FTD OCT 62 164 Thle lorna euperaed F'm 164. Jul 61, which ie obaolete tl. IF you sow the obiect at NIGHT, what did you notice concerning the ~TARS und MOON? 8.1 ST AR5 (Circle One): d. Dor.'~ remember 8.2 MOON ((ircle One): a. Bright moonlight b. Duf.l moon I ight c. No moonlight -pitch dark ~ .uonrt rememSer:> 9. What wer~ the weather conditions ot the time you saw the object? CLOUDS (Cirele One): WEATHER (Circle One): a. Clear skv 'b:-Fog, mist, or light rain c. Scattered clouds c. e'V\oderote or heavy rain d. Thick or heavy clouds e. Don't remember 10. The object :Jppeared: (Circle One): 0. Solid [ ._";'a As ca I ighC b. T:-cr.s;:::o~ent e. Dot1 't remember If it oppeare:: cs a light, was it bris:.. r than the brightest stars? (Circle One): c. About the same u: m mer d. Don't know 11. 1 Com~ are brightness to sorn. col":'lmo object: 12. The edges of the object were: (Circle One~: a. Fuzzy or blu!":-ed = Sn:Jr!'ly ovtlf;1ed cl. Don't remember 13. Did the object: a. Appear to stand still at any time? b. Suddenly s~ed up and rush away at any time? c. Breck up into parts or explode? d. Give off smol<e? e. Change brightness? f. Change shope? g. Flash or fl ic:lcer? h. Disappear and reappear? (Circle One for each question) Don't know Don't know es Don't know Don't know Don't know Don't know Don't know Yes Don't know 14. Did the ob' ct disappear while you were watchin it? If so, how? 15. Did the obj.c:t move b-.hind aomething at any time, ptJrtlculorly a cloud? (Circle One): IF you answered .ES, then te II whot 16. Did the object move in front of something at any time, particularly o cloud? (C ire Itt Out}: Yes Don't Know. IF you answ~tred YES, then tell-what 17. Tell in a few words the following ~ ings about the ect: We wish to know tn angular si:te. Hold a match stick at arm's length in line with a known obiect and note how the obje~ is covered by the head of the match. If you had performed this expe. i the time of the sighting, how r,uch of the object would have been covered by the match head? Drew c pie re rhat wi II show the shape of the obiect or obiects. Lobel and include in your sketch any detai Is of the obie~t :~at you saw such os wings, protrusions, etc., and especially exhaust trails or vapor trails. Place art cr-ow ~side the drawing to show the direction the obiect was moving. al. Do you thinlc you can estimate the spMd of the obiect? (Circle One) feS' No .~ IF you answerecl YES, then what speed would you estimate? _6./~/11-~t.::-, 21. Do you thir.lc you can tintate h"ow far away from you thtt object was? (Circle One} IF you answered YES, then how 'for away would you say it was? 22. Where wer~ 'fOAJ located when yCAJ saw the obiect? 23. Were you (Circle One) (Circle One ): a. In th& business section of a cit-t? a. Inside a ~uilding~ (~. 'In the residentiol section'of a cif)'"t/ c. In open countryside? c. Outdoor~ d. Neor ':n airfield? d. In on a irplane (type) e. Flying over a city? f. Flying over o pen country? 24. IF ycu w~,.e MOVING !NAN AUTC."':81LE or other vehicle ot the time, then complete the following questions: 24.1 What di rection were you mot' ir ? (Circle One) South West Northeost d. S.:>utheast f. Southwest h. Northwest 24.2 How 'est were you moving? miles per hour. 24.3 Did you stop at any time wh i !e you were looking at the obiect? (Circ le One) 26. In order thct you can give as clear a picture as possible of what you saw, describe in your own words a common obiect or object s which, when placed up in the sky, would give the some appearance as the obiect which you saw. 27. In the followif'g sketch, imagine that you oe ot th~ point shown. Place or .. A., on the curved I ine to show how high the object was above the horizon (sky I ine) when you I irs t sow it. Place a s., on the same curvll!d I ine t~ show how high thl! object was above the horizon (skyline) when you lost saw it. Place an "A" on the cnmpass when you f irst saw it. Place a "B" on the compass where you last sow tlac object 2 8. t)row o pic-vr~ that will show t ne rnorion that the obiect or objects mode. Place an "A" at the beginning of the h path , a "b,, :t the end of the po , c"ld show any changes in direction during th.: course 29. IF there w::s ~R~ THAN ONE object, then how many were there? ------------ Draw o p ic t ure of ho~ they were orrcnged, anJ put on arrow to show the direction that they were traveling 31. Was onyor-e eisa with you at the time you saw the obiect? (Circle One) 31.1 IF you onswerd YES, did they see the obiect too? (Circle One) Yes 31.2 P lease list their names ond addresse': I 32. Please g iv~ rhe following information about yourself: TELEPHONE NUMB Indicate any -,dditionol information obout yourself, including any special experience, which might b1! pertinent 33. Wh.n ond to whom d id you report thot y u had seen the obiect? 34. Date you completed thl1 que1tionnaire: 35. Information which you f .. l pertinent and which i1 not adequately covered in the 1pecific polnt1 of the que1tionnoire a narrative explanation of your sighting c.e ca.;c_;, ARTMENT OF THE AIR FORCE HEADQUARTERS P'OftEIGN TECHNOLOGY OlVISION (A,SC) WRIGHT ... ATT&RSON AIR P'OIIIC& Aaa. OHIO s43a UFO Observation , 2 R-e rence your unidentified observation. 'nle information which we have received is not sufficient for a scientific evaluation. ReqJ.est you complete the attacherl FrD ForaL 164 and return it in th~ envelope provided. Thank you for reporting your observation t c the Air Force. Colo::-el, USAF of Technology end Subsystems F~D Form 164 v/envelope