PROJECT 10013 RECORD 2. LOCATION Collierville, 1. DA 1 F. TIME GROUP (multiple) 10. CONCLUSION 3. ~;nur.cE (other) lNSUFFIClS'i~ DATA FOR EVALUATION 4. NU~U~[ R OF OBJECTS ~. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS 15 minutes . SEE CASE 6. T'fPE OF OBSERVATION Ground Visual 9. PHYSICAL EVIDENCE r:To SfP 63 0-329 (TOE) Pnlou edltlOft of thh Iota lftY b ".,~ 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 hove observed. Please 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, 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 did you see the object? 2. Time of day: 3. Time Zone: Month Year (Circle One): a. Eastern C:.l>. : Cerrtr.aP c. Mountain d. Pacific 4. Where were you when you saw the object? Nearest Postol Address (Circle One): (Circle One): a. Daylight Saving City or Town State or County 5. How long was object in sight? (Total Durotion) Hours Minutes-Seconds a. Certain c. Not very sure (.--b. F~idy cert';;i;J) 5.1 How was time in sight determined? d. Just a guess 5.2 Was object in sight continuously? 6. What was the condition of the sky? a. Bright c.,.lLv/\; ]. IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object? (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 This form :ouperaedea FTD 164, jul 61, which is obsoleht o. If-you saw t lte obtec t or NIGHT, what d ed you not ice concern eng the 5 TARS and MOON ? STARS (Circle One): MOON (Circle One): Bright moon I ight b. Dull moonlight c. No moonlight -pitch dark Don't remember d. Don't remember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One}: NEATHER (Circle One): (9Ciear sky b. Fog, mist, or I ight rain c. Scattered clouds c. Moderate or heavy ro in d. Thick or heavy clouds d. Snow e. Don't remember 10. The object appeared: (Circle One): (a.) Solid b. T ransporent d. As a I ight e. Don't remember 11. If it appeared as a light, was it brighte r than the brightest stars? (Circle One}: a. Brighter c. About the same b. Dimmer d. Don't know 11.1 Compare brightness to some common object: 12. The edges of the object were: (Circle One): a. Fuzzy or blurred b. Like a briyht star ( c.-StiarplY=()(1fti neJ) d. Don't remember 13. Did the obiect: a. Appear to stand still at any t ime? b. Suddenly speed up and rush away at any t ime? c. Break up into parts or explode? d. Give off smoke? e. Change br ightness? f. Change shape? g. Flash or fl icker? h. Disappear and reappear? (Circle One for each question) Don!.t-krrow. " on t now Don't kno w Don't know Don't kno w Don't know Don't know Don't know Did the object disappear while you were watching it? If so, how? "' 15. Did the object move behi"d something at any time, particularly a cloud? (Circle One): Ye~ Don't Know. IF you answered YES, then tell what it moved behind: 16. Did the object move in front of something at any time, particularly a cloud? (Circle One): Yes Co-~\ Don't Know. IF you answered YES, then tell what 17. Tell in a few words the following things about the object: 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 much of the object is covered by the 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 picture that will show the shape of the object or objects. 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 an arrow beside the drawing to show the direction the object was moving. 20. Do you think you c on estima t e the speed of the object? (Circle One) Yes ; No / IF you answere d YES, then what speed would you estimate?-~ {J .aJyf'r . 21. Do you think you con estimate how for away from you the object was? (Circle One) IF you answered Y ES, tnen how far away would you soy it was? .:._/ _ z_ / ),L-L - 22. Where were you located when you saw the object? (Circle One}: 23. Were you ( Circle One) a. In the business section of a city? b. In the residential section of a city? ( In ope; untryside!: a. Inside a building -D.In a co~ c. Outdoors d. Near an airfield? d. In on airplane (type) e. Flying over a city? f. Flying over open country? IF you were MOVING IN AN AUTOMOBILE or other vehicle of jhe time~hen complete the following questions: 24.1 What direction were you mo~ng? (Cirde One) 1 - a. North c". t:ost r 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 looking at the object? (Circle One) Yes No observe the object through any of the following? Eyeglasses Yes Binoculars Yes b. Sun glosses Yes Windshield Theodolite Window glass 26 . In order that you can g ive as clear a picture as possib le of what you saw, describe in your own words a common ct or objects which, when pla c e d up in t he sky , would give the s ome appeara nce as the o b ject which you sow 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 a .. B., on the some curved line to show how high the object 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 sow the ob1ect 28. Draw a picture that wi II show the motion that the obiect or obiects mode. Place an "A" at the beginning of the path, a "B" at the end of the path, and s !.u .. .:.ny changes in direction during the course. 29. IF there was MORE THAN ONE obiect, then how many were there? -F-=---=-...::::~....L..::.~.J---'----- Draw a picture of how they were arranged, onJ put on arrow to show the direction at they were traveling 30. Hove you ever seen this, or a simi lor object before. If so give date or dates and location. 31. Was anyone else with you at the time you saw the object? (Circle One) 31.1 IF you answered YES, did they see the object too? (Circle One) 31.2 Please I ist their names and address~s: 32. Please give the following information about yourself: M iddle Nome C ity Zone TELEPHONE NUMBER Indicate any additional information obout yourself, including any special experience, which might be pertinent When and to whorr. did you ~eport that you hod seen the o!Jject?/ Day Month Year