l. [)A I F. i IME GROUP 2. LOCATION NlH'.E~[ R OF OaJECi'S CONCLUSION G~her(?syc~olo~ica:; ~. LENGTri Or 06SERVAi'ION T'I'PE ur .jr1SERVA liON ! ~. Prl OTOS PHYSICAL EVIDENCE 11. BRIEF SUMMARY AND ANA~ YSIS t.o movl3 to . .,ard, c.bovc appearec ~na~ e c 0 oe:cause ~IJ e.~an ~o ::.ove ~usband was on the sed th<.! objact. Prevloue edltione o: thllt form c.10y h \hoed. U.S. AIR FORCE TECHNICAl. INFO RMA TI01~ Thia questionnaire haa been prepared so that you can yive the U. S. Air Force 01 much information as poasible concerning the unidentified aenol pheno,T"enon that you hnvu oLtserve1i, Please try to answer as many questlona aa you p,ssibly can. The information that )'~U give witf be ueed for reaeorch purposes. Your name will not be used in connec.tion wHh any st~ttrTeeni;~, conclusions, or publications without your permission. We request this personol Information 1e that if it is deemed necessary, we may contact you few further details. 1. When did you aee the object? 3. Time Zone: (Circle One): /0':' Eastern~ 6-!Cen tra I c. Mountain d. Pacific 4. Where were you when you saw the object? Postal Addr S. How long was obiect in sight? (Totol Ourotfon) t.tb5 t'.lwl-f 1 a. Certain b. Fairly certain 5.1 How was time In sight determined? 5.2 Wos obiect In sight continuously? 6. What waa the condition of the sky? Hourt Mlnutea c. Not very sure Stota ~ Cowrt; 7. IF you sow th obi"ct during DAYLIGHT, wh~r was the SUN located as you lock~d ae the ob;e~t? .( C lrcle One): a. In front of you b. In back of you c. To yovr ris;,flt d. To your left e. Overheod f. Don't remember FTO OCT62 16~ ~ Thle fo."' aupereecles JP"ro 164, Jul 61, whlch le obenlete. 8. IF yov sow tho ob1ect ot N 1Gt1T, .,..,hot d td yCY.J nol rce concerning tha STAR) and MOON? r b. Dull moon l i ht -:. t.'lf< J/ , , c r: "' c. No moonlight - pitc:h dark d. Don't rmember d. Don't rememtier 9. What ..... ,. tne ~otner ~oncletions at the time yau aaw the object? CLOUDS (C~rde One): La. C lenr alt "\ c. s~atte: .. d ctuvJ~ WEATHER (Circle One): l.. fog, mast, Of le~t ro1" c. Moderate or hea.,y rain e. Don't renwsmber 10. The obittct appeared; LO Sold) ' b, T run tpc,aenf (Circle One). cf. As o light e . Don't remember 11. If it appeared aa a light, waa it brighter than the brighteat stan? (Circle One): a. Brighter c. About the ~ame b. Oimnter d. oont know 11. 1 Compare bri ;htneaa to aorr:e common ot,lect~ 12. The edg.a of the obiect were: ((,,do ';:,e) a. Fuzzy Of blurred h. L itce a bris,-ht stor '. Sharply out I ined d. Don't remember a. Appear to atancl atill at any time? b. Suddenly speed up ond rush away at any time? c. Break up into porta ot explccle? d. G1ve off smol<e? e. Chan;. brig,tness? f. Change shape? g. F laah or fl iclcr? f ; h. Dtsappear end reappear?' (Circle One for ead' question) Dcn't know oont know oont know oont know ocnt lcnow oont know Don't lmow Don't know 15. Did the obiect move behind 5omethHl9 at any time, particui\Jrly a cloud'! ( C ire le Onft J: Yes Don't Know. IF you .:J.lswerotl '([;,, then fttll '"hot it moved behind: 16. Did the object mava in front of ~pmething at any tame, port icu larly a cloud? (Circle One): Don't Know. in front of: 17 . Tell in a few words the following things about the obiect: ~ ' We wish to know the angulor size. Hoi~ a match stkk ot arm~ length in lintt with a known o_bie:t one' 14':' .. j~r I much of the obiect is covered by the head of the match. If you had performed this experiment a t thr, tir.).; ' .:.~ I sighting, how much of the object would hove been covered by the match head? I Draw a picture that will show the ~hope of the obiect or obiects. Label and include in your :aketch any detc:.n$ of the object that you saw .. uch aa wings, protrusions, etc., and especially exhaust troih or vapor trails. Place on arrow beside the drawing to show the direction the obiect wo s moving. .J-.-r r.r-; '-'-.S f~ ,,._.' -c-- C. ;tO. Do you think you can estimate the speed of the object? (Circle One) (:fJ No IF you answered YES, then what speed would you ostin.ote'f 21. Do you think you can estimate how far away from you tht~t object was? (Circle One) If you answered YES, then how far away would you say it was? 22. Where were you locotttd when you saw the oblect? (Circle One): o. Ins ide a building c. Outdoors d. In on airplane (type) 23. Were you ( C; r cltt Ontt) tr; the business section of a city? Ira th<~ residential S\)Cfic.u vi n city? In Ol>fm country~ide? } N"ar an a~rtield? Fl-ying over a city? Fly ;nv o~er open coontry? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete tha followia.g queatiMa: 24.1 What direction were you ~noving? (Circle One) ;:;: Norffl) b. Northeast d. Southeast f. Southwest h. Northwaat ~t. How ast were you moving. ---=~=-~&;,.:.;_;..._mi es per our. 24.3 Did you stop atony time while you were looking at the obiect? (Circle One} ~ No 26. In order that you can give 01 clear a picture as possible of what you saw, describe in your own words a corumOft object or object which, when placed up in the sky, would give the some appearance oa the obiect which ) 'OU aa In the following a~ etch, lmotlne that you ore at the point ho"'" P loc: <m '' J.. '' o" '~ r:urv: I m., to a how ho .... high th ot,lect wo1 abcwe the horlaon (alcyltne) when yw llrtt sow If. Ploc8 'J "8'' on the 1.1me r.;ur~ed line :c. ahow how high the obiect woa abov the horizon (tlcyllne} whn ynu last ,uw 1t. Piece un ' f..' on the tompllsf whn you llr1t aaw lt. Ploce o "8" on tht com~ where you loJt aaw the ohieet. 28 . Draw a picture that wi II show the motion that the obiect or obiects macfo. Place an "A' al rhe beginni~19 CJt 1he path, a "8" ot the end of the path, and show any changes in direction during the ~ouno. . 29. IF there was MORE THAN ONE obJct, then how naany were there? utt /r . -/ 'II I~ I Draw a picture of how they were arranged, ond put on arrow to show the directio that thoy wertt travufing 30. Hov you evet ~n thit, 01 a aimilor obiset b.fcre. If 10 g ive date or dents end locotion. 31. Was anyoM elae with you at .... time you saw the ohiect? (Circle One) 31.1 IF you answered YES, did they see the obiect too? (Circle On) 31.2 PI I itt their names end oddresses: 32. Plaoae give the following I tlon about youraelf: TELEPHONE NUMBE Indicate any oddltlonal lnfor,.,.tlon about youraelf, Including any 1p.clal experience, which might be pertirtn, . Whn and to whom did you repcwt that you had n the object? Da1 Month Year 35. lnfctmotlcn which you feel pertinent ond whl . . --------------1 quatlannolre 011 o norratl I ch Ia not adequately covered in the apeclflc polntl of th v exp onation of your alghting