:.IME G~OU? i 2. LOCATION ' 3. ~iOlJP.CE , 4. NlH~P.ER OF OBJ~CIS l S. LENGTH OF OSSERVATION {,. Tl'PE '--OBSERVATION l g. PtiOTOS PHYSICAL EVIDENCE CONCLUSION 11. BRIEF SU)wo.MARY AND ANALYSIS to\':arci tf'le cm\Tft:Ura i:: s<:-vcr~l 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. Ple~ue try to answer as many questions as you possibly can. The information that you give will be used for research purposes. Your name will not be used in connection with any statements, cone !us ions, or publications without your permission. We request this personal information so that if it is deemed neee s sory, we may contact you for further deta i Is 1. When did you see the object? 3. Time Zone: (Circle One): a. tastern b. Centre! c. 1-J.oun~ in d. Pacifrc (Circle One): (Circle One): a. Daylight Saving b. Standard 4. Where were you when you sow the object? Nores1 Postal Address City or Town 5. How long wcs object in sight? (Toto! D uration} <... o. Certain-~ ~. Fo irly certain c. Not very sure d. Just a guess State or County 5.2 Was c!:>;ec1 ir. s ight continuously? 6. What was t he condition of the sky? b. C lou b. Cloudy 7. IF you sa;the-~et during DAYLIGHT, where was the SUN located as you looked at the obiect? (Circle One): a. In fro'"rlt--of you d. To your left b. In bock ol~ e. Overhead c. To your right f. Don't remember FTD OCT 62 164 Thla rorm auperudea FTO 164, jul 61, which ia obsolete. 8. IF you sow the object at NIGHT, what did you notice concerning the STARS and MOON? 8.1 STARS (Circle One}: d. Don't remember 8.2 MOON (Circle One): a. Bright moonlight ,: h:-ou-n moon11ght-;, c. No moon I ight -pitch dark d. Don't remember 9. What were th~ weather conditions at the time you saw the object? CLOUDS ( C ircle One}: WEATHER (Circle One}: b. Fog, mist, or light rain a. Clear s ky c. Scattered clouds c. Moderate or heavy rain d. Thick cr ;,eavy douds e. Don't remember 10. The objec! appeared: (Circle One): d. As :1 I ight e. Dor 't remember 11. If it op or os a light, was it bri;~!er than the brightest stars? (Circle One}: a. Brighter c. About the same b. C immer d. Don't know 11.1 Compere-brightness to some comr:1on object: 12. The edges o! t~e obje::t were: (C ire fe: 0 .-e ): a.., Fu-zz bL.med at' ~ b. I ike e bri~! sor c. Sharply outlined *'"-'Q\ "=>~c-~cM..lc".,.;j 13. Did the object: a. Appear to sto~d still at any time? b. Suddenly s;>eed up and rush away at any time? c. Breck u~ i1to ports or explode ? d. Give off smoke? e. Cha nge brig'l tness? f. Change shape? g. Flash or flicker? h. Disappear and reappear? (Circle One for each question) c:r~s~- t~o Qes Oi\1([ ) No Don't know Don't know Don't know Don't know Don't know Don't know Don't know 14. Did the object disappear while you were watching it? If so, how? 15. Did the object move behif'd something at any time, particularly a cloud? ( C i rc /e One ): it moved behind: tj b .. _. IF you answered YES, then tell what 16. Did the o!:>ject move in front of something ot ony time, particularly o cloud? (Circle One): Yes Don't Know. IF you answered YES, then tell what 17. Tell in o few words the following th ings about the object: We wish to <now the angular s ize. Hold a match stick at arm's length in line with a known object and note how much of the object is covered by tt,e head of the match. If you had performed this experiment at the time of the sighting, how much of the object would have been covered by the match head? 19. Draw a pi.: re that will show the s hape of the object or obiects. Lobel and include in your sketch any details of the objecT t~c:t you sow such os wings, protrusions, etc., and especially exhaust trails or vapor trails. Place on o"ow b'! s ide the drowi ng t~ show the direction the obiect was moving. 20. Do you think you con estimate the speed of the object? (C ire le One ) IF you onswe.-ed YES, then what speed would you estimate? _!...-p_:i c -.t.<-~-o "-~fl . cd-h .. -..,~ . 21. Do you th ir.~ you con estimate how far away from you the object was? (Ci rcle One) IF you a nswered YES, then how for away would you soy it was? 4- - ".: .......... _. - Were you (Circle One ) 22. Where were y ou located when you saw the object? (Circle One:: In the business section of o city? In the residential s ection of a city? In -~pen ~ount;;s-ide?) d. Near on airfield? a. Ins id e o Suilding b. In o cor d. In on air;:>lone {type) e. Flying over a city? e. At se~ f. Flying over open country? 24. li= you were MOVING IN .A:N--AUJOMC3lLE or other vehicle at the time, then complete the following questions: Whot d irection were you mov in;? (( ir~le One) o, Norm c. East e. South b. Norheost d. Southeast f. Southwest h. Northwest 24.2 How fest were you moving? _.Jmiles per hour. 24.3 Did y:>u stop at any time while y~v were looking at the obiect? (C ir e le One) 25. Did you cSs~:-ve ~he object through c r.y of the following? Eyeglcz s~s b. Sun 9 lcs3: s Window glass Binoculars Theodolite 26. In order that y~u c on give as clear a picture as possible of what you saw, describe in your own words a common object or obje:ts which, when placed up in the sky, would g ive th e some appearance as the object which you saw. 27. In the following sketch, imagine that you are at the point shown. Place an "A" on the curved line to show how high the object was above the horizon (sky I ine) when you first saw it. Place a "B" on the same curved I ine to show how high the obiect 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 obiect Or ow o pict .:r~ that w i II show the m~t ion that the object or objects mode. Place on "A" at the beginning of the p~t;,, o "B ' ' ot the end of the path, C!'1d s!.v,., \lny changes in direction during the course. 29. IF there wos MORE TRANON~ ?b1ect, then how many were there? ----------- Draw a pic~ure ~f how they were o;r~'n;~d,..o.!:!.=l put an arrow to show the direction that they were traveling. 30. Have you ever seen this, or a similar ob;ect before. If so give dote or dotes and location. 31. Was anyone ~lse with you at the time you saw the obiect? (Circle One) 31.1 IF you answered YES, did they see the obiect too? (Circle One) 31.2 Pleose list their names and addresses: 32. Please g iv e the following information about yourself: First Name ADDRESS 1 E'X fj Q "'-LJ Zone State TELEPHOs= NUMBER----------- Indicate o:-:y odditional information about yourself, including any special experience, which might be pertinent. 33. When and t o whoT. did you report that you had seen the object? Day Month Year 34. Date you completed this questionnaire: 35. Information which you feel pertinent and which is nat adequately covered in the specific points of the questionnaire or a narrative explanation of your sighting. This is in reply to your letter of' Saptember 13 1ega.rding your unidentified flying object sighting. Plea3e excuse our delay in replying to your l etter; a heavy backlog of correspondence has precluded a protapt reply to your inquiry. Unfortunately, -'i th the information provided in your letter, -w-e are u:mble to positively id~ntify ";hat you obaer.red on September 1 1966. There were no UFO reports from the Lake Champlain area submitted to the ProJect Blue Book off"ice. I am inclosing iTD Form 164 ' "hich is used in ma.king UFO reports to the Air Force. If you lo!Ould like to complete this fo.:.n and re- S:.!~mi t your 1nfon:ati.Jn ve will then attempt to tra k e an evaluation Tha.nk you for your letter; your interest in our progrs.m is e.p~recia.ted. E:<::zout.n, Devon, Great Britain GEOIUB P. FREEMAN, JR Lt Colonel, USAF Chief, Civil Er.anch Cowmm1ty Relatione Divia!on Office of Ini'ormation