j 1. C':'A 1 F. 71ME GROUP 2. LOCATION t Nt~;;;E R OF OBJECTS ~). LENGTH OF OBSERVATION None Not e d If,, TT'PE OF OBSERVATION Gr ound Visual I~. PHOTOS ~ ?. PHYSICAL EVIDENCE 10. CONCLUSION INSUFFICIEt IT DNr ~ ?CH lo;/1\ LUATION 11. BRIEF SUMMARY AND ANALYSIS r TD s f p 6 3 0-329 (TOE) Prevloue edltlon of thla fOI'IIl me)' be u ... rl . U.S. AIR FORCE TECHNICAl. IHFORMATIO~ Thia questionnaire hat been prepared 10 that you can \live the U.S. Air Force as much information as potsible concerning the unidentified ael'ial phtnoanenon that you hravu obse"'eci. Pleat try to answer as many question as you possibly can. The information that yc.:u ; ive witf be used for research purposes. Your name will not be used in conne(;tion with any st~terraeni:~, conclusion, or publications without your permission. We request this personal lnform:Jtion flC thot if it is deemed necesaory, we moy contact you for further details. 1. When did you the obieet? (Circle One).(O. Eas.t.ern--) o.-central c. Mountain d. Poe iflc 4. Where were yOY whan you saw the object? { C 1rcle One): (Circla L1ne): a. Daylight 5o: inn b. Star"~darcJ Neareat ottal Aclclrea S. How long waa obiect in alght? (Total Duration) Houra Minutes Seconch ......_a. Cert~in =:: c. Not very sure b. Fairly certain d. Just a guess 5.1 How wos time In sight determined? --------------------- 5.2 Was object in sight continuously? 6. What woa the condition of the tky? .. NIG.tl.I_ ( /-a. Bright 7. IF you aaw the object during DAYLIGHT, whre wa1 the SUN located os yo\.1 lock~d a~ the ob;e~t? ( C lrc:le One): a. In front of you b. In bock of you c. To your ri~t d. To your left e. Qverhaocl f. Don't remember FTO OCT 62 164 Thl fa."' uper .. d PTD 164. jul 61. whlch h obeDlet 8. IF you 1;aw the ol,p,ct ot NIGtiT, whut did yo.J n otece conc:erneng the STARS and MOON? 8.2 MOON (C.trcle One): 6ri~t m~laght Dull moonlight No moonlight - pitch darlc Don't remember Don't remember 9. What .... ere the ather condetions at the time you 1aw the objttct? CLOUDS (C'rde One): a. Clenr 1ky c. s,arter .. d cloud s d. Th t<., c>t he\l'Y cl~d ~ WEATHER (Circle One): ia. fog, mest, 0t le~t ro11a c. Moderote or hea.,y rain Oont remember 10. The obi ttct appee1red; (Circle One). d. ~s Q light . b. Tn:tntpment e . Don't remember 11. If it appeared 01 a light, woa it btight8r than the brightest stars? (Circle One): ( Brighter _.,' c. About the some d. Don't know 11. 1 Compare lwightneas to aon:e common obJect: 12. The edoe oi me obiect were: fC 1 "~ lo C;ne) a. F uz xy or blurrd Like" bright star Sharply outlined d. Don't remember 13. Did ~e ob1ect: (Circle One for each queatlon) Appear to stand ati II at any time? Don't lcnow Suddenly speed up and rush away at any time? No Don't lcnow c Bteak up into porta ot explod? Don't know Give off smoke' Yea No Don't lcnow Chana-brid'ttneas? Don't ltnow f. Chong. Jhape? Don't know Don't 1cnow r laJh or flicker? h. Draopp.tor and reappear? Don't know 1.&. D id th!' object disappear while you w e r<. to tchtng rt? It !; o , how? Did the obiect move behind somethtng at any time, particul1.1rly a cloud'? (Circle Ontt): Yes , No / Don't Know. IF Y"u .:~.,swered '([;,, thtm tttll "'-'hot it moved behind: _ 16. Did the obieet move in front of ~pmething at any tame, p rnticularly a cloud? (Circle One): Yes No Oon't Know. IF you answer of! YES, th~ ~ P wi,lt 17 . Toll in a few words the following things about the obiect: We wish to know the angular size. Hofd o match stick at arm" length in lin~ with o known ubiott anc:' 1: r.-r ';,H much of the object is covered by the head of the match, If you had perforrneJ this experiment at th tir;..,; .. ~:.~ sighting, how much of the ob;ect would have been covered by the match head? 19. Draw a picture that will show the shape of the obiect or obiects. Label and include in youl' sket~h any deto;IA of th obiect that you saw such oa wings, protru&ions, etc., and eapeeially exhaust trailt or vapor trails Plac:a an arrow beside the drawing to show the direction the obiect was moving 20. Do you tnmlc you can estimate the speed of the object? (Circle One) IF you answered YES, then what speed would you estin.ate'f 21. Do you think you con estimate how for away from you thct object was? (Cirde One) IF you answered YES, then how for away would you soy it was?----- _ 22. Where wer you located when you sow the oblect? Wero you (Circlu On~J (C ,c:ltJ One): in the business section of a city? Inside o building ~. h. rhe residential S\!t:tic,n d a city? I 0. b. In a cor In opfln coun try~ide? c. Outdoors d. Nt:lor an airfield? d. In on airplane (type) Fl'ying over a city? Fly;n~ over opera C04Jntry? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete thft followit.g queationa: 24. 1 What direction ware you '"oving? (Circle One) 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 ot the object? (Circl One) Yes No 25. Did you obaerv the obict through any of the following? Eyeglaa e. Binoculars Sun glass f. Telescope Yes c. Windahield Theodolite Yes No d. Window glaas 26. In order that you can give as clear a picture aa possible of what you aaw, describe in your own wotcls o commOf' object Of obiecta which, when placed up In the slcy, would give the soma appearance as the obiect which } ' OU so~ . In th~ followl.,o a~tt:h, lmogl" tn'lt you \lr ot tht pol M 1ho'llfn. fJI l un ''A'' o" d,.., r:u,,J,.: lm~ to ~how h.., ... high th oblect woa obcwe the horlaon (tlcylln) when yeA.~ llrJt tow lt. Ploc~ '1 ''B" on the a.Jme <;Ur"ed line :c. how how high the obiect was above the horiaon (skyline) when ynu last ~uw 1t. Piece un ' '/A, on th c:omptJAJ when you ll11t aow lt. Place a "B" on tht compoas where you lo1t tow the ohiect, 28 . Draw a picture that wi II ahow the motion that the obiect or obiects mado. Place on A ' or tho boginn;:,g ot 1he path, a "S" at the end of the path, and show any changes in direction during the -.:ourae. 29. IF there was MORE THAN ONE obJect, the" how mGny were there? -- Draw a picture of how they wre orrongd, and put on arrow to ahow the direetion that they wertt travvlin~. 30. Have you ever '''" thi 1, or a aimi lor object before. If ao give dott or dates ond location. 31. Was anyone else with you at ftte time you saw the obiect? (Circle One) 31.1 IF you anawered YES, did they the obiect too? (Circle One) 31.2: PI lilt their names end addresaea: 32. Pleoae give tht following lnfmatlon about youraelf: r lrtt Naffte Jt.? rr t_ c_ lncUcote any oclclltlonal lnform.tlon about youraelf, lnc:lucUng ony 1peclal t)Cperlence, which might be pertlnnr 33. Whan a~ to whom did you rpott that you had n the obiec:t? DC:PAHTMENT OF THE AIR FORCE HEADQUARTERS I'OREIGN TECHNOLOGY DIVISION C AFSC) W .. IGHTPATTE .. SON AUt I'O .. CE liAS&. OHIO A:SA33 UFO Observation, 23 I;;;,~ Reference y~>ur unidentified observation. The 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. 'JAMES C. MANATI', Colonel, USAF ~1Jirector of Technology and. Subsystems FTD Form 164 w/envelope