NUMBeR Of 03JECTS TYPE OF OBSERVATION Ground ~Jisual : 9. PHYSICAL eVIDENCE 10. CONCLUSION aGC!'c!SS. FTD SEP 63 0.329 (TOE) I ((lf-l~t' U.S. AIR FORCE TEC:1N1CAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force as much information as possible concerning the unidentified aeria I phenomenon that you have observed. Please try to onswer as many questions as you possibly can. The information that you give will be used for research purposes. Your nome 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: (Circle One): 3. Time Zone: (Circle One): b. -cen-tral c. Mountain d. Pacific (Circle One): a. Doylig_b Saving ~ ;)tandora 4. Where were you when you saw the object? Nearest Postal Address City or Town State or County 5. How long was object in sight? (Total Duration) Minutes Sec:onds ( o. Certain ' c. Not very sure b. Fairly certain d. Just a guess 5.2 Was object in sigh.t continuously? 6. What was the condition of the sky? c-a. Bright _ 7. 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To your right d. To your left e. Overhead f. Don't remember FTD OCT 62 164 Thls form supersedes f'Tn 164, jul 61, which is obsolete, ~. IF you sow the object at NIGHT, what did you notice conce1rn ing th e 5 TARS a nd MOON? 9. What were the weather conditions at the time you sow the object? CLOUDS (Circle One): HEATHER (Circle One): c ~. C ~e_or skV.? b. Hazy b. Fog, mist, or light rain c. Scattered clouds c. .~oderate or heavy rain d. Thick or heavy clouds d. Snow e. Don't remember 10. The object appeared: (Circle One): ~sa light_j e. Don't-remember b. Transparent If it appeared as a light, was it brighter than the brightest stars? (Circle One): Ca. 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 Like a briyht star Sharply out I ined d. Don't remember 13. Did the obiect: a. Appear to stand still at any time? b. Suddenly speed up and rush away at any time? c. Break up into parts or explode? d. Give off smoke? e. Change brightness? (Circle One for each question) f. Change shape? Flash or flicker? 1 fd , Yes Don't know Don't know Don't know Don't know Don't know Don't know Don't know Don't know h. Disappear and reappear? 14. Did the object d isapooor whi lo you we re watching it? If so, how? 15. Did the object move beh i~d something at any time, particu lorly a cloud? (Circle One): No 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 No Don't Know. IF you answered YES, then tell what Tell in a few words the following things obol!t 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 hod performed this experiment at the time of the sighting, how much of the object would have been covered by the match head? 19. Drew a picture that will show the shape of the object or objects. Lobel and include in your sketch any details of the object that you sow such as wings, protrusions, etc., and espec iolly exhaust trails or vapor trai Is. Place on arrow beside the drawing to show the direction the object was moving 20. Do you think y ou con estimate the sp~ed of the object ? (Circle One) (~ ~ No 21. Do you think you can estimate how for away from you the object was? (Circle One) IF you answered YES, then how for away would you soy it was? 22. Where were you located when you sow the object? (Circle One): 23. Were you (Circle One) a. In the business section of a city? a. Ins ide a building b. In the residential section of a city? b. In a car c. In open countryside? c. Outdoors d. Near an airfield? d. In an airplane (type) 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) c. East e. South 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 Did you observe the object through any of the following? Eyeglasses Yes No B inocu Iars b. Sun glasses Yes No Windshield Yes g. Theodolite Yes No Window glass In order that you con give as clear a picture as possible of what you sow, describe in your own words a common object or objects which, when placed up in the sky, wou !d give the same appearance a'S the object which you saw. 27. In t he following sketch, imagine that y ou are at the point shown. Place an "A" on the curved I ine to show how igh the object was above the horizon (sky I ine) when you First saw it. Place o "B" on the same curved I ine to show how high t he object was above the horizon (skyline) when you last saw it. Place an "A" on the compass when you First saw it. Place o "B" on the compass where you lost saw the obJect 28. Draw a picture that will show the motion that the object or objects made. Place on "A" at the beginning of the path, a "B" at the end of the path, and shu,., ~ny changes in d irection during the course. 29. IF there was MORE THAN ONE object, then how many were there? ----------- Draw a picture of how they were arranged, on.:J put on arrow to show the direction that they were traveling 30. Have you ever seen this, or a simi l or object before. If so give dote or dotes 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 i st their names and addresses: 32. Please give the following information about yourself: TELEPHONE NUMBER Middle Name Indicate any additional information about yourself, includi ng any special experience, which might be pertinent When and to w horr. d id y ou r e port t hat y o u hod seen t he obj ec t ? 34. Date you completed this questi onnaire: _)~: .. - 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