PROJeCT ~C.J73 CORD DA Tf. ""iME. GROUP Ci vil:.ar. 4. NlJMBE R OF OBJECTS S. lENGTh OF OBSERVATION TYPE OF OBSERVATION 3rot::1:t Visual PHYSICAL EVIDENCE 10. CONCLUSION cv~ .. luDtion 11. BRIEF SW"'.~ARY At-.;0 ANALYSIS OOJ eC~o~ !:lC ely 5 ~ours. FTD SfP 63 0-329 (TOE) Prewloye edlUona of thh tona .. y be yaed U.S. AIR FORCE TECHt~ICAL IHFORMATION This questionnaire has been prepared so that you con give the U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you have observed Please try to answer as many questions as you possibly con. The information that you give will be used for research purposes. Your name wi II not be used in connection with any statements, conclusions, or pub I ications without your permission. We request this personal information so that if it is deemed necessary, we may contact you for further detai Is. When did you see the object? 2. Time of day: (Circle One): Day Month Year 3. Time Zone: (Circle One): ~ fa stern . Central c. Mountain d. Pacific (Circle One): a. Daylight Saving 4. Where were you when you saw the object? Nearest Postal Address C i ty or Town ,, 5. How long was object in sight? (Total Duration) a. Certain @Fairly certain 5.1 How was time in sight determined? 5.2 Was object in sight continuously? 6. What was the condition of the sky? c. Not very sure 1 d. Just a gue s 7. IF you saw the object during DAYLIGHT, where was t he SUN located as you looked at the object? (Circle One): a. In front of you b. In back of you c. Toyourright rJ. To your left . e. Overhead f. Don't remember FTD OCT 62 164 Thi s form supersedes FTD 164. j u l 61. which la oba oleto 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 moon I ight b. Dull moon I ight . No moonlight -pitch dark Don't remember 9. What were the weather conditions at the time you saw the obiect? CLOUDS (Circle One): WEATHER (Circle One): @ Clear sky b. Fog, mist, or light rain c. Scattered clouds c. Moderate or heavy rain d. Thick or heavy clouds d. Snow e. Don't remember 10. The object appeared: (Circle One): d. As a light b. Transparent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): c. About the same d. Don't know 11.1 Compare brightness to some~ common obiect: ~ 12. The edges of the object were: (Circle One): a. Fuzzy or blurred b. Like a bright star ~.:. Sharply outlined d. Don't remember Did the object: Appear to stand still at any time? Suddenly speed up and rush away at any time? Break up into parts or explode? d. Give off smoke? e. Change brightness? f. Change shape? Flash or flicker? Disappear and reappear? (Circle One for each question) Don't know 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 behind something at any time, porticu larly a cloud? (Circle One): Yes (}f}iJ Don't Know. IF you answered YES, then tell what 16. Did the object move in front of something at any time, particularly a cloud? (Circle One): Yes Don't Know. IF you answered YES, then tell what Tell in a few words the following things about the obiect: 18. We wish to know the angular size. Hold a match stick at arm's length in line with a known object and note how the object is covered by the head of the match. If you hod performed this experiment ot the time of the sighting, how much of the object would hove been covered by the match head? 19. Draw a pictu~e that will show the shape of the object or obiects. Lobel and include in your sketch any details of the obiect that you sow such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place on arrow beside the drawing to show the direction the object was moving. 20. Do you think you con estimate the speed of the object? (C ire le One) IF you answered YES, then what speed would you estimate? 21. Do you think you can estimate how far away from you the object was? (Circle One) Yes IF you answered YES, then how far away would you say it was?---------- 22. Where were you located when you saw the object? (Circle One): (i;' Inside a building b. In a car (!) Outdoors d. In an airplane (type) 23. Were you (Circle One) a. In the business section of a city? I,.~ 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? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 24.1 What direction were you moving? (Circle One) a. North c. East e. 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 loolcing at the obiect? (Circle One) Did you observe the object through any of the following? a. Eyeglasses Binoculars b. Sun glasses f. Telescope Yes No c. Windshield g. Theodolite Yes No d. Window glass 26. In order that you can give as clear a picture as possible of what you saw, describe in your own words a common object or objects which, when placed up in the sky would give the same appearance as the object which you saw 27. In the following sketch, imagine that you ore at the point shown. Place an "A" on tne curved I ine to show how high the object was above the horizon (skyline) when you first saw it. Place a "B" on the some curved line to show how high the object was above the horizon (skyline} when you last sow it. Place an "A" on the compass when you first saw it. ~e o "B" on the compass where you last sow the object. . 28. Draw a picture that wi II show the motion that the object or obiects mode. Place an "A" at the beginning of the path, a "B" at the end 9ft path, and s~.ut. uny changes in direction during the course. 29. IF there was MORE THAN ONE object, then how many were there? --3--d--------- Oraw a picture of how they were arranged, and put on arrow to show the direction that they were traveling. JO. Have you ever seen this, or a simi lor object before. If so give dote or dotes and location. 31. Was anyone else w ith you at the time you saw the object? (Circle O ne) 31.1 IF you answered YES, did they see the object too? (Circle One) 31.2 Please list their names and addresses: aJ..) ~ ~ 32. Please give the following information about yourself: First Name TELEPHONE NUMBER Indicate any additional information about yourself, including any special experience, which might be pertinent 33. When and t o whom did you report that you had seen the ob'ect? 34. Date you completed this questionnaire: 35. Information which you feel pertinent and which is not adequately covered in the specific points of the questionnaire or a narrative explanation of your sighting