PROJECT iCOi'3 RECORD . . 1' O'A l E T !ME GROUP 2. LOCATION .' _' NlJI.'.OER OF OBJECTS 5. LENGTH OF 08SERVATION 50 r.iinutcs TYPE OF 01'\SERVATION PHYSICAL EVIDENCE 11. BRIEF SUMMARY AND ANALYSIS ::-.uch brirr.t.~. 3 0 . Hove y ou ever seen this, or a simi lor object before. If so give date or dates and locat ion. 3 1. Was anyone else with you a t the t ime you saw the object ? (Circle One) No 31.1 IF you answered YES, did they see the object too? (Circle One) 31.2 P lease list their names and addresses: 32. Please give the following informat ion about yourself: Lost Nome First Nome Middle Nome f"lt ~ t..J t. J-tv Zone S tate TELE PHONE NUMBE Indicate any additional information about yourself, including any special experience, whi~h might be pertinent . flJO {IJ I 33 . When nnd to wh:>n-clid you rC'p':)rt thot 'I"'U hod S"~n tl,.n objec-t ? 27. In the following sketch, imagine that you ore at t he point shown. Plac e on "A" o n the curved line t o show how the object was above the horizon (skyline) when you first s ow it. Plac e o "B" on the s o me c urved line t o show how hi gh the ,bject was above the horizon (skyline) when you last saw it. Pla ce o n "-A" on the compass when you first sow it. Plac e a "B" on the compass where you las t saw the object . 28. Draw a picture that will show the motion that the ob ject o r objects mode. P la c e an "A" at the beginning of the path, a " B" at the end of the path, and shu..., ~>ny c hanges in direc tion during the course~" A ~til~f. l"toRE <..-JiTMbv r S7'0 /Jf ttll.;. orf?. S ,_o<->IIUG. Rt fli Pr fin. .ll'tH f' ~ 29. IF there was MORt: THAN ONE obje ct, t hen how many were there? --~f~<? l> I( ~.n,t.thi.Jt. tl C.o..nJ~ o Draw a picture of how they were arranged, and put an arrow t o show th~ d ire c ion that the y we re traveling 34. Date you completed this questionnaire: Day Mont h Year 35. Information which you feel pertinent 'ond which is not adequately covered in the specific points of the 8 . IF you sow the obre c t a NIGHT, what drd you n o t rce cc- cNnrng th e ~TARS and MOON? 8. 1 STARS(CrrclcOrcJ: d. Don't rem~mber a. Aright moonlight Dull moonlroht (c. No moC'nlrght -pr t c!l dar Oon ~"t remember .-/ 9. What werr the weo t h--r :::o .. :litions at th e time you s o w 1,,. obje c t ? CLOUDS (Crrclc Orr). G C lear ~kO b. Fo.l, ' o r lrgl,t r"li'l c . Scattered cloud" c. Mocf.!r11r~ or heavy ror'"l d. T h ic k o r heavy c l-,uds d. Snow 10. The object oooeored ((,,.:::(,. On,.); ca;-. -A-:-c; o I i ghy b. T ron s poren t e. Don't remember 11. If it opreored os a ligh, was it brrqhter than the brightP , ~tnrs? ( Crrrlr. Ot~c): o . Brigh~ c. About th e so.,..c- d. Don't know 11. 1 Compare brightn ... H to some common object: 12. The edges o f the obre:-t were: (C irclc One): o. Funy o r blurred b. L ;~.. bn~ht stor c-c-.-s-::~o-~iy outlined~ 13. Did the obrect : Aop r o r t o c;tond s t i ll nt nny t r,..r ? b. Suddenly c;oe ccl up ont1 ruo;h nwoy a t any time? c. Brco~ uo rnto oort' "'' ex oiC"~I"., f. Change shop~? g. F lash o r flicker'> h. D i soon,.o r ord r"o;>oe-c r '> (Ctrdc Otw f o r eCICh question) Don't know Don't ~now O o n ' t kno w Don't know Don't kno w D('On't k n o w U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force as much in formation as possible concerning the unidentified aerial phenomenon that you have observed Please try to answer as many questions as you possibly can. The informat ion that you give will be used for research purposes. Your name wi II oot be u sed in connection with any s tatements, conclusions, 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 d id you see the object? Hour Mi nvte s (Circle One): 3. Time Zol'}e: (Circle On e):(O. Eastern) b. Central (Circle One): a. Dayl ight Sav ing b. Standard c. Mountain d. Poe ific ~. Where were you when you saw the object? Nearest Postal Address C it y or Town 5. How long was object, in sight? (Total Durat ion) Hours Minutes Se conds <g; Certa(y c. Not very sure b. Fairly certain d. Just a guess 5.2 Was object in sight continuously ? 6. What was the condition of the sky? (Circle One): a. In front of you b. In back o f y ou c. To your r ight d. T o your left e. Overhead f. Don't remember Thla form aup01raedea fo' TO 16 4 , .Jul 61, w h le:O. I obaolete. 20. Do you think you con estimate the speed o f the object? (Circle One) <9 No IF you answered YES, then what speed would you estimate? 21. Do you think you con estimate how for away from you the object was? (Circle One) IF you answered YES, then how for owoy would you soy it was? 22. Where were you located when you sow the object? (Circle One): 23. Were you (Circle Ouc) In the business section of a city? a. Inside a building b. In the residnntial sect ion o f a city ? b. In o cor ( c. In ope n countrysidc).l d. Near on orlicld? d. In on airplane (type) e. Flying over a city? At sea f. Flying over open country? 2.4. IF you wf!re MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 2.4.1 What direction were you moving? (Circle One) a. North c. East c. South g. West b. Northeast d. Southeast f. Southwest h. Northwest 24.2 How fast were you moving?------_miles per hour. 24.3 Did you stop at any time while you were looking at the object? (Circle One) Yes Did you observe the object through any of the following? Eyeglasses Yes e. Binoculars b. Sun glosses Windshield g. Theodolite Yes Window g loss 26. In order th a t you con give as c lear a pic t ure as possible of what you sow, describe in your own words o common object or objects which, when placed up in the sky, would give the some ap~eoroncc as the object which you sow . 14. Did the objec t disappear while you were watching it? If s o , how? 15. Did the object move behind something a t a ny t ime, particularly o cloud? (C irclc One): it moved behind: _ Don't Know. IF you answered YES, then tell whCJt Did the objec t move in front o f s ometh ing a t any tim:, particula rly a clo ud? (Circle One): e No Don't Know. IF y ou answered Y ES, then tell wha t front o f: Tell in a few words the fo llowing things about the object : 18. We wish to know the angular s1ze. Ho ld o ma tc h s t ick at arm' s length in line with a known object and note how much o f the object is covered by the head of the match. If you hod pcrformud th is experiment o t the t ime of the sighting, h o w much of the object would hove bee n covered by the matc h head? ~ /\ _,A ) 19. Draw a picture that will show the shape o f the object o r objec t s . Lobe l and include in your sketc h any d etails of the object that you sow such os wings, protru sions, etc., and especially exhaust tra il s or vapor trail s . Ploce on arrow beside the drawing to show the direc ti on the objec t was moving . 30. Hove you ever seen this, or a simila r object before. If so give do te or dotes and locati on. 31. Was anyone e lse with you at the t ime you sow t he object? (Circle One) No 3 1.1 IF you answered YES, did they see the object too? (Circle One) No 31.2 Please! list their names and addresses: 32. Please give the followin g information about yourse If: Lost Nome Middle Nome City Zone S tote T ELEPHONE NUMBE S E X _f1ALE Indicate any additional information about yourself, including any special experience, which might be pertinent 27. In the following sketch, imagine that you ore at the point shown. Plac e on "A" on the curved I in e to show h ow high the object was above the horizo n (skyline) when you first sow it. Plac e a "B" on t he s ome curved line t o show how high the object was above the horizon (skyline) when you last sow it. Place on "A" o n the compass when you f irst sow it. Place a "B" on the compass where you last saw the object. Draw a p icture that wi ll\ show the motion tha t the object or objects made. Plac e on "A" at the beginning of t h path, a "B" at the end of t he path, and s!.v ..... ny ::honges in dir.,cllon during the course. 29. IF there was MORE THAN ONE object, then how many were there? --~w:;. : ;:_ _ Draw a p ic ture of how they were arranged, and put on a rrow t o show the direction that th~y were traveling. l l:,u cubi:-~. V~;ilt:.\ ll.l 34. Dote you completed this questionnaire: 35. Informat ion which you feel pertinent and which is not adequately covered in the specific points of th e questionnaire or a narrative explanation of your sighting . ,L., ~uu{;JIIo,-: llitO "tOo Nemo for th~ Record: At appro::d.mately 2351Z 17 Oct. 66 Et::ho I I \/filS over 79. 2:1 40~1 and on ;"~ northerly h""ading. It app~3rs that th~ initial obs~rv4tion "ns of t.,he st.::~r Cap~""lla which ,;n.s rising in the m;E p.:!.rt of t~e