PROJeCT 10)71 ~' CG;:(O nn -t.r.r :I Nt ii:P.ER OF O SJECTS I '>. LENGTH OF 0 3SERVATI ON l :.: 1 'I"PE OF OBS VATION 17. C:OURSE EVl D!:NCE ' 2. LOCATION ?et~r!lon, 10. C ONCLUSIOI-0 ll. BRieF SUMMARY AND AI-:At. Y! U.S. AIR FORCE TECHNICAL IN FORMATION -:-his questionnaire has been prepared so that you con give t he U.S. A ir Fo rc e as much info~mcr:l ., a s possible concerning the unidentified aerial phenomenon tha t you hove obs!!trved lecse y t:> answer as many questions as you possibly con. T he in formation t hat you give w i ll be Jse c for r!!seorch purposes. Your nome will not be used in connection w ith any statements, c~nc'ustons, or publications w ithout your permission. We reque s t this personal information so thcr :F it is deemed necessary, we may contact you fo r further details. When did ~ou see the object? Hour Minutos (Circle One):-l : onth Y ear 3. Time Zcre: (Circle One): a . caster~ .d. Wh~re were-you wne n you sow t'-:~ c:: i~ct? (Circle One); a. Daylight Saving :' b ! Standard City or Town Stoto or County 5. How bns ":S o::::>; e c t in sight? (":'::r':ll Duratic.n ) o. Cetoin c. No t very sure ':::. =::irly certain 5.2 Vros ~:: !:-::- -si;h~ continuous!y? at wos t,e =-=-::ron or t e s-<y: c. S r ight b. Cloudy , , I.', /~) Just a guess I{ a. Bright , .-b.\ Cloudy 7. IF you s ow the object during DAYLIGHT, where was the SUN located as you looked o t the objec t ? (Circle One): o. In front of you b. In bock of you c . To your r ight d. To y o ur left e . Overhead f. Don't remember FTD OCT 62 164 Thl a form aup,.ra"tl" " FTn 164, J u l 61, whlc~ Ia obs olet,.. 8. I F you sow t h e ob1e c t a' NIGHT, what did you notice cc-:::Nning t h e STARS and MOON? 8.1 STARS(CirclcOnc): cf.' Oon't remember r 8.2 MOO~ ( C rrc/e One): a . B right moon I ight b. Dull moonlight '.:,c)> No moonlight -p itch dark d. Don't remember 9. What were the weotner conditions at the time you sow the object ? WEATHF.t1' (Circle One): Clea r skv b . Fog, ..,;:;t, o r light roin Scattee::! cloud c: c . Moderot" or heavy rain ::r heavy :: e. Don'~ rc..,ember 10. T h e objec oopeored: ( C ircle One): d. ~so light T r o-"' s ::crl!fnt t remember 11. If it opo~o-ed as o light, was it br!f"1Ter than the brighte:-;t ~tors? (Circle One): o . a richter c . About the sa.,(' d. Don't know Comoor~ br ishtr>-,$ s to s o,...,e commo n obje c t : 12. T h e e d ge s cf t,e !:lci~ct were: (Circl~ :.,-e o. Fuzzy or Sl~rred 13. Did t h e objecT: ::>. L i~"! -bri~-t srar ::. SC:c ... :-lv outH~ed Appe::lr !o ~tc:i"ld s t i ll ot any t ime? Sud de., ly soeed up and rush away at any time? Bre o< u;:~ :r-to ports ::>~ cxolode? Give otf SMO ? Chor.ge Sri s'l h?S s? Change sh ope? Flash o r flicker ? Disappear ar.d r~oppecr? (Circle One for each question) Don't know Don't kno w )'rs ' No . Don't know Don't know Don't know Don't kno w on' t know Do n't know 14. D id the object disapoeor whi lc you were watching it? If so, how? 1 15. Did the .:oe~t move behir~d something a t any t ime, particularly o cloud? (Circ I<" :;re ): No Don' t Know. IF you answered YES, then tell wha t 16. Did the o~:ect move in front of so,..,et:,ing a t any time, particularly a cloud? (Circle One): No Don' t Know. . IF y ou/answered YES, then tell what 17; T ell in o few words the following 18. We wish ~:l Kr.ow ::--e angular s ize. :old o match stick o t a rm' s length in line with o know n object and note how much oft-~ object is covere<l by ~ne head of the match. If y ou hod performed this exper iment a t the time of the sighting, ~ow much o f the object '"'ould have been covered by the match head? . 19 . Drew a show the s'cp~ of the objec t or objects. Lobel and include in your sketch any d etai ls of the ob:ec-----"~u sow such o s w ings, protrusions, etc. , and especially exhaust trails or vapor trails. Place en cr-::..., -esd~ t'-te drawins tv show the direction the object was moving. 20. Do you think you can estimate the speed of th e object? (Circle One) Yes I F y ou answered Y E S, then what speed would you est imate?-------- 21. Do you thin~ you can estimate how far away fr om you the object was? fC ircle One) Yes) No) \. ., ,. IF you cnswere d Y E S, then h ow for a way would you say it was? 22. Where w!:'e you located when y ou sow the object? (C trcle :]:1e ): 23. Were you (Circle One) o . In the business section o f a city? b. In the residential section o f a city ? o . lnsi== .;:~building In .;; car c. In open countryside? c . Or...~ :~oars d . Near on airfield? In c, airplane (type) e . F lying over o city? f. Flying over open country? 24. I F yo~.. ""ere MOVING IN AN ,; JIOMOBILE or o ther vehicle a t the time, then complete the following questions: 2~. 1 '(fhat direct ion were you :noving? (Circle One) East e. South b. Nort7leost d. Southeast f. Southwest h. Northwest 24.2 !-:ow f ast were you mov1ng? Jl.-i les per hour. 24.3 Did you stop ct any t ir.1e w!,ile you were looking at the object? (Circle 0.1e) Yes No Did you c~s~ve th e o!>ject tl,~:~ugh any o f the following? !:y.a;l-::ss~s e. Binoculars Yes No Ye s No f. Telescope Yes No Theodolite Yes No In order ~,cr you can give as clear o picture as possible of what you saw, describe in your own words o common objec t or -:>b;ects which, when placed up in the sky, would give the same appearance as the object whic h you sow In thtt follow ing sketch, imagine that you ore at the point shown. Ploctt on "A" on thtt curved line to show how the obje c t was above thtt horizon (skyline) whttn you first sow it. Ploc tt a " B " on the s ome curved l ine t o show how high th e object was above the horizon (skyline) when you last saw it. Place on "A" on the compou ~en you first :;cw it. Place a "B '' on the compass where you last saw the object. ~3. o~::w a pi::~.vre that w i ll show ~he :;, ct:on that the object or objects mode. Place on "A" at the beginning of the pcth, o ''c" ot ~:,e end of the po:,, ~nd shu.,.. .1ny changes in direc t ion during the course. D raw c Ft::~vre Y ._ow they were :rr::r:ged, and put an arrow to show the direction that they were traveling. 3 0 . Hove you ever seen this, or a similar object before. If so give d ote or dotes a nd location. 31. Was or.yor e else with you a t the t ime you sow the object? (Circle One) !r you answered YES, did they see the object too? (Circle One) 31.2 Plecse I is ! their names and addresses: II}\ Tfif~, information about yourself: Middle Nome TELEPHONE NUMB Indicate :;ny oc!ditional information about your self, including any special experience, which might be pertinent. 33. When and to wn o m did you report that you hod seen the object ? 34. Date you complete d th is questionnaire: 35. Information which you feel pertinent and which is not adequately covered in t he specific points o f t he qu9stionroirt'l c r o narrat ive explanation o f your s ight ing.