1. l>A TE 'tIME GROUP 2. LOCATION Holly Eill, Florida I~:ultipl~ ; - t. Nllt.~BER OF OBJECTS ~. LENGTH OF OBSERVATION 10-15 rd.nutes t.. TYPE OF OBSERVATION Ground Visual r.:ot Stat~d a. F~IOTOS 19. PHYSICAL EVIDENCE 10. CONCLUSION Form 164 sent over 30 days, and not rhturned a s of this dat, .if f orm is returned, siehti~g \iell be evaluat~d. i I 11. BRIEF SUMMARY AND ANALYSIS Dbs~rver sta~d objett split up, chRnged colors and hover~d; Object ap~eared 'trhite at first, t hen suddenly i t stated to chanrsed colors.. vbj ect \'Jas al.l!lost perfectly disc shaped. Cbject apr-eared to fall t hen ro~e above the horizon and out F T D S E I" 6 3 0-329 (TO E) Prevloua edlUona of thh fo1 as m1 b u .. d 14. Did tne obiect disoop.,or wh.l~ y ou .....,.,,. watching it? If so. how? Yes . It s~eed~d out of 15. Did th abiet:t move t,...hind 5om"'thinq at a ny time, ptJrticulorly a cloud? (Circle OneJ: ~ Don't Know. IF you answered YES, then tell whot it moved beh lnd: it moved a Servioe_Clenter.._ ~- _.,. 16. Did the obiect move in frnnt of som~thinq at any ''"'"' p<'rticu larly a c laud? (Circle Omt}: Q' .. ~ No Don't Know. IF you on$wered YES, then tell whet in front of: _j..._t _m_gyeJL . .in fr.o.nt of Hansard Is s~rvice_ Cente~ ------ 17. T ft II in a ffllw words thtt followinq things about the object: No sound at all. First it appear~d white, then changed colors to red & blue then white. 18. We w ish to know the angular size. Hold o matc:h stick at arm's length in line with a knt)wn ob!ect and note how much of the object is covered by thtt hand of the match. If you had oerformed this ex~rirn4tnt at th, time of the sighting, how much of th-.t ob!ec:t would hove been covered by the match head? (;~\l '( r\ FRr1CTiCid L-~r~T (<)F T+IE 0 ~seci) , Draw a picture that wi II show the shape of the obiect or obiects. Lobel and include in your sketch any detai Is of the obiect that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trai Is. Place on arrow beside the drawing to show the direction the obiect was moving. 20. Do you think you can estimate the speed of the object? (Circle One) IF you answered YES, then what speed would you estimate?-------- 21. Do you think you can estimate how for c;woy from you the object was? (Circle One) IF you answered YES, then how for away would you say it was? --------- Where were you located when yO'J sow the object? (Circle One): Inside a building d. In an airplcne (type) 23. Were you (Circle One) (o. In the business section of o .city?} h. !n the residential section of a ci~y? c. In open countryside? 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 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) 25. Did you observe the object through any of the following? Eyeglasses Binoculars Sun glosses f. Telescope Wind.sh ield Yes No Theodolite Yes No d. Window glass 26. In order that you can give os clear a picture as possible of what you saw, describe in your own words o common objsct or objects which, when placed up in the sky, would give the sam., appearance as the object which you sow .. It looked like a rocket exploding or a meteor 27. In the following sk.,tch, imagine that you o~c at th.!t point sho~.Vn, Place or "A" on rh~ c u rved I i11e to show h:>w high the object was above the horizon (skyline) when you first sow it. Place a ''B'' on t h e :.ame curvttd I ina to show how high the object was above the horizon (sky I ine) when you last sow it. Placf! an ... A" on the compos s when you lirs t saw it. Place a "B" on the compass where you lost sow the object 28. Oraw o picture that wi II show the motion that th'! object or objects made. Place .an "A" at the beginning of the .. poth, a .. B" at the end of the path, and show any changes in direction during th~ ct:>urse. p(.)R' f tOkJ 0 F 29. IF there was MORE THAN ONE object, then how many were there? _ _,SIE.:i=x"'--..... --------- Draw a picture of how they were arranged, anJ put on arrow to show the direction that they were traveling 30. Hove you ever seen this, or a simi lor uhject before. If so give data or do:ea and locatign. 31. Was anyone else with you at the time you saw the object? (Circ/8 One) 31.1 IF you answer ... d YES, did they see the object too? (Circle One) 31.2 Please list their names end addresses: Holly Hill, Florida , Ormond Beach, Florida Beach, Florida Hill, Florida .olly Hill, Florida 32. Please give the following information about yourself: TELEPHONE NUMBER Firat Name Mfclclle Name Zone State Indicate any additional information about yourself, including any special experince, which mignt be pertinent; I believe that there are U. F. 0. s and life on other planets. 33. When end to whom did you repOft that you had seen the object? 7 _December 1966 34. Date you completed this questionnaire: Information which you feel pertinent and which is not-odequote.l~ covered in th.-specjfic points of the 35. questionnaire Of a narrative planation of your sighting Two other people on the other aide ot town also sa~ it II!IEII'L. Y TO DEPARTMENT OF THE A I R FO~CE HAOQUA~TE:~5 F"O ICN TEC~NOLO~Y OIVI:JIO N f A :: 9C> WRIGHT.,.An'ltRSON AU. f'OJitC&: 8AS~. OHIO 4!5~33 UFO Observation Reference your unidentified observation. '!be information which we have received is not sufficient for a scientific evaluation. Request you complete the attached FTD Form 164 and return it in the envelope provided. Thank you for reporting your observation to the Air Force. S C. MANATI', Colonel, USAF rector of Technology and Subsystems FTD Form 164 w/envelope WA' J-: .PeLt ()/\ AJ\ tlntQ ecw~ C (f)) tJ ~vtr_ . ~ . G.rv ~0 c s/Gv -Ovnd ~ Ml t&-rlo1V<i~ lTs ~ T\\'O persons report.ed seem \ unidentified f\y\ng ob)ect.a o'ie ; the na.yton.a Bea.cb. Are 'IUe5 daY night. Walter woodruff and hiS son. Bill. 1'\, reported spot.t\ni a. UFO at about 9:15 p.m. We were si.t,ting 1.n our living room watching televl..sion when we nrst noticed a la,rge oo}ect coming towa.rd our w\nd~,'' said woodruff . woodr.lff sa\d be and his son watched the beXa.iooal sba.ped object tor about nve. minutes as It remained st.atloaarY a.lJOU\ a quarter mUe from their home at 10 s. PeninSula Dtive. He said i.t beg~n ,tn().vlng sout.b, made an abrUPt turn to the , east and continued a<~er the 1 ': ocean-TheY o\)Set'Ved the oblect lit with o\ue, green, red and 1 ~eUoW Ughts. tor about 2<l : minutes, ne se.1d.-' \ "!1[\lte prultt, 1613 Eliln Drive. r eported spo~ U F 0 batw een 10:30 and 11. ~hile on the beach e.'oO'Ut one mile north ot Granada. Ave. in ormond Beach. The tOund objeCt na4 a. sma.U squ.a.re o&se undetDeAtb and no lights. he s a.id. It was the rcnect\.on of the street lights ott the base'' that made \.t vis\ b\e, Pruitt said . \ The UFO was about 150 teet \ over his Ma.d. movin~ from eas\ t o west G.t !!0 to '25 mph, a.c co:din:; to J?ru\.tt. 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 inforiTiation that you give will be used for research purposes. Your name wi II not be used in connection with any statements, ccnclusions, or publications without your permission. We request this personal i"formotion so that if it is deemed necessary, we may contact you for further details 1. When did you see tha object? (Circle One): 3. Time Zone: (Circle One): (Circle One): o: c. Mountain d. Pacific 4. Where were you when you saw the object? _._H_Qlly Hill, City or Town 5. how long was object in sight? (Toto! Duration) ~. _Certain) c. Not very sure b. Fairly certain d. Just a guess Daylight Saving . _ Florida State or County 5. 1 How was time in sight determined? _ :e~s~t~i:il!jm!.iilautue.od.._t.x..i.,..miJileL- _ 5.2 Was object in sight continuously? Yes _:j No --- 6. What was the condition of the sky? 7. IF y ou 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 bock of you c. To your right d. To your left e. Overhead f. Don't remember F TD OC T 6 2 164 Thl form aupo,rudea FTO 154 , r u i At . whtch ia ob~ol~t.-. ~. IF yo u s:~w the object ot NIGitT, wha t dto yt"lu notice concernng the ~TA~S .md MOOt'~? 8.1 STARS (Circle One): d. Don't remember 8.2 MOON (Ctrcle One): G. :Bri;~t moonli~ht) b. Dull moon I ight c. No moonlight -p itch dark d. Don't remember 9. What. were the weather conditions at the t ime yoo sow the object? CLOUDS (Circle 0;1e ): NEA THER (Circle One): Clear sky ) Hazy b. Fog, mist, o r light rain c. Scattered clouds ,'~oderote or heavy rain Thick or heavy clouds Don't remember 10. The object appeared: (Circle One): (a. Solid) d. Asalight b. T ran spcrent e. Don't remember 11. If it appeared os a light, was it brighter than the brightest stars? (Circle One): (a,-:righter (A"t:Tir<!ts)") c. About the same d. Don't know 11.1 Compare brightness to some common object: It lookmi like a neon 1_1 a it got brighter ~lld~d~jm~!!'~ .. ~er~!. _ 12. The edges of the object were: (Circle One): Fuzzy or blu:-red ..a brii:Jht star Sharply outlined"' d. Don't remember 13. Did the object: a. Appear to stand still at any time? b. Suddenly speed up end rush away at any t ime? c. Break up into ports or explode? d. Give off smoke? e. Change brightness? f. Change shape? g. Flash or flicker? h. Disappear ond reappear ? (Circle One for each question) Don't know Don't know Don't k:1ow Don't know Don't know Don't know Don't know Don't know