i 1. OA 1[ TtM~ GROU? 2. L.OCA ;ION L lian Aircr;. .f't(possible) j 1. NlJHC\ER OF OBJECTS S~ LENGTH o;: OBSERVATION 20 seconds 6. TYPE OF OBSERVATION Grounci Visual 7 . COURSE 11. BRIEF SUMMARY AND ANALYSiS 4 The object disappeareG. behina a -c,rce o.-:-1C.. r, tl~u ~'c: 'ted. T'ne descri'8tion is co:!sist.er.~ w::..th \.i:o.t o: .. an .:d~c . .ft obs~rvo.tion. Freta -:! in:'or:::c-~.\.iO:l sub:nitt.:;c a:: a:i.rcr:.:t ?. PHYSICAL EVIDENCE could have be~n res~c:1sible for the observ~\.~on. fTD SCP 63 0-329 (TOE) Prevlou edition of thh form my be u .. d. 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 t-:-L"On't U.S. AIR FORCE T ECrtNI CAL 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 have 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 detai Is. 1. When did you see the object? (Circle One): Day Month Year 3. Time Zone: (Circle One): ,~):~stela ) b. Central c. Mountain d. Poe ific e. Other 4. Where were you when you saw the object? (Circle One):~ Daylight S i ,'Qi b. Standard Nearest Postal Address State or County 5. How long was object in sight? {Total Duration) Hours Minutes a. Certain c. Not very sure b. Fairly certain (d. J,us~. ~ gu!_sV 5.1 How was time in sight determined? Ay 4-.or-aiap tf' o A" 5.2 Was object in sight continuously? Yes No ./ 6. What was the condition of the sky? ra-:-Br i qh_j) 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 .(J.To d~ b. In back of you e. Overhead c. To your right f. Don't remember FTD OCT 62 164 Thi:J form auperaedes F TD 164, Jul 61, which ia obaotete. 8. IF you sow the objec t at NIGHT, what did you notice c o ncerning th e STARS and MOON? STARS (Circle One): MOON (Circle One): a. Bright moon I i gh t A few b. Dull moon I ight c. Many 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): .(clear sk~ c. Scattered clouds d. Thick or heavy clouds WEATHER (Circle One): b. Fog, mist, or light rain c. Moderate or heavy rain e. Don't remember 10. The object appeared: (Circle One): b. Transparent d. As a I ight e. Don't remember 11. If it appeared as a li ght, was it brighter than the brightest stars? (Circle One): a. Brighter c. About the same d. Don't know 11.1 Compare brightness to some common object: 12. The edges of the object were: (Circle One): o. Fuzzy or blurred b. Like a briyht star ~-Sharply outl med d. Donrt remember 13. Did the object: (Circle One for each question) Don't know Don't kno w Don't kno w a. Appear to stand sti II at any time? b. Suddenly speed up and rush away at any t ime? c. Break up into parts or explode? d . Giv e off s m Don't know Don't know Don't know No., Don't know Don't know e. Ch~nge brightness? f. Change shape? g. Flash or flicker? h. Disappear and reoopear? Did the object disappear while you were watching it? If so, how? ' 15. Did the object move beh i~d something at any time, porticu lorly a cloud? (Circle One): Don't Know. IF you answered YES, then tell whot 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 17. Tell in o few words the following things about the object: 18. We wish to know the angular size. Hold o match stick at arm's length in line with o 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 hove been covered by the match head? 19. Draw o picture that wi II show the shape of the object or objects. Label and include in your sketch any details of the object 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 can estimate the s peed of the object? (Circle One) IF you answered YES, then what speed would you estimate? _ --------- 21. Do you think you can estimate how for away from you the object was? (Circle One) 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): cr=:lns i?e a bui ldin9) c. Outdoors d. In on airplane (type) 23. Were you (Circle One) In the business section of a~? In the res id;,:.ti~l .section of a city]) In open country side? d. Near on 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 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) 25. Did you observe the object through any of the following? a. Eyeglasses Yes e. Binoculars Yes b. Sun glasses c. Windshield Theodolite d. Window glass 26. In order that you can give as clear o picture as pass ible of what you sow, 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 ~ketch, imagine that you ore at the point shown. Place on "A" on the curved l ine to show how the object was above the horizon (~kyline) when you first sow it. Place o "B" on the s ame curved line to show how high the object was above the horizon (skyline) when you lost saw it. Place on "A" on the compass when you first sow it. Place a "B" on the compass where you last sow t he object. 28. Draw a picture that wi II show the motion that the object or objects mode. Place on "A" at the beginning of the path, a "B" at the end of the path, end shv~ ~ny changes in direction during the course. 29. IF there was MORE THAN ONE object, then how many were there? ----------- Draw a picture of how they were arranged, and put on arrow to show the direction that they were traveling. 30. Hove you ever seen this, or a sjmi'Jr object before. If so give dote or dotes end 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 obiect too? ( Ci rc/e One) 31.2 Please list their names and addresses: 32. Please give the following information about yourself: ast Name Middle Name TELEPHONE NUMBER Indicate any additional information about yourself, including any spec io I experience, which might be pertinent. 33. When and to whom did you report that you had seen the oSject? :~"/ I