O:.S VATION Pt1YSICAL EY:~::;~.:E ?r.,vlous o c!lt!o n 30. Hove you ever seen this, oro similar object before. If so give date or dotes and location 31. Was onyot"!~ else with you at the time you sow the obiect? (Circle One) 31.1 IF yo.; llnswered YES, did they see the object too? (Circle One) 31.2 P lease I i st their names and addresses: 32. Please giv~ the following information obout yourself: First Name TELE?HO~E NUM tndicot~ a ny ~dditional information c~ut yourself, including any special experience, which might be pertinent. 33. When and to whom did you report that you had seen the object? Month Year 34. Dote you completed this questionnaire: 35. Information which you feel pertinent and which is not adequately covered in the specific points of t he questionna ire or a narrative explanation of your sighting. "UFO" Reporting Data: a. DlfBCRIPIION OF THE OBJECT(Sl: Ret ur n t o : Infox~wation Division lst Ftr Wg (ADC) SAFB, Mich. 4804~ (2) Size compared to a known object (use one of the following tarm3: Head of~ pin, pea, dime, nickel, qu~rter,halt dollar, silver dollar, bas~ba1: , grapefruit, or basketball) held in the hand at a~out arm's Formation, if more than one (6) Arry discernible f eatures or details ;.../l_/ _f _/,_.1_(:..-------- including size of same compared to size (7 ) Tail, trail, or exhaust, I I Other pertinent o~ unusual featurea~/~-+i~f -'~J-.(.,, r-_ ... ~ (1 ) wnat first ca11~d the att~ntion of observer(s) to the object(s)? Ar.gle or elevation and azimuth ol-object{s) when first observ~d. (3) - l~ or elevation and azimuth of object(s) upon dis appearance. Description of flight path and maneuvers of object(s) . How did the object(s) disappear ? Instant~eously to th~ North, How long were the objects(s) visible? (Be specific, 5 minutes, \ I I il I UFO" Reporting Data (continued) c. MANNER OF OBSERVATION: (1) Use one or any combination ot the following item~: Gro':: .. d-visual, air-visual, ground-electronic, air-electronic. (If electronic, ! Y type ot radar. ) (2) Statement as to optical aids {telescopes, ~inoculars, et c &) ~sed and description thereof. (3) I the sighting occurred while air-borne, give type of aircraft, identification number, altitude, heading, speed, and home station. d. TI!-1E AND DATE OF SIGHTING: (1) Zulu time-date group of sightinqg_-_.//,_ dawn, dusk.) conditions. (Use one or the following terms: night, e. LOCATION OF_OBS~VER(s). Give exact observer, and/or-geographical positione latitude and longitude of e~cn f. IDENTIFYING INFORHATION ON OBSERVER{ s): {1) Civilian -Name, age, mailing address, occupation, and est ate of reliability. (2) }filitary -Name, grade, organization, duty and estimate of reliability. ADC~l Cmbt Spt Gp-CDC Selfr1age A~B,.Mich. J'lf'LY TO TD.m'/tJFO DEPARTMENT OF_;THE AIR FORC~ HEADQUARTE .. S FOPt!:IGN TECHNOLOGY DIVISION f A'SC > WRIGHT.PATTitR!JON AIR FO!I'tC~ ft~tt:t. OHIO 41~<4-'3 UFO Observation , 17 Feb 67 }.1t. Cle1:1ens M1chig3n 48043 Re:':!:-ence your unidentified observation, 'The inforl't".e.tion which ~e ve received is not sufficient for a scientific evaluatibn. Re est you complete the attached F'TD Form 164 and return it in the envelope provided. Thank you for reporting your observation to the Air Force JA:-::..s C. MANATI', Colcne 1 , USAF Di::-e;ctor of Technology and Subsystems F~D Form 164 v/envelope "UFO" Reporting Data: Return Lo: Informat ion Div.!3ion 1st Ftr He (ADC) SAFD, Nich . 480Ll-5 a. DFSCRIP';r'ION OF :I'HE OBJECT(S): (2) Size compared to a known object (use one of the following terms: Head ot & pin, pea, dime, nickel, qu~rter,.~alt dollar, silver dollar, baseball, grapefruit, or basketball) held in the hand at a~out arm's ( 4 ) Number Formation, if more than one (7) Ta.il, trail, or eN~aust, including size or same compared to size Other pertinent or unusual features P. l-: t ,..--,.; / .{ ' b. D~S,:?.IPT I ON OF COUP.. OF OB,JECT S : ~iha.t :t'irat call-~d the attention of observer(s) to the object(s)? (2) Ar.gle or eleva on and azimuth of object(s ) when first observed. or e evavJ..On and azimuth of object(s) upon disappearance. (4) Description of flight path and maneuvers of object(s) How did the object(s) disa ppear? Instantaneously to the North, long were the objects(s) visible? (Be specific, 5 minutes, "UFOH Reporting Data (continued) c. MANNER OF OBSERVATION: (1) Use one or any combination or the following items: Gro't!..'1d.-visual, air-visual, ground-electronic, air-electronic. (If electronic~ ecify type or radar. ) (2) Statement as to optical aids (telescopes, ~inoculars, etc.) .used and description thereof. (3) If the sighting occurred while air-borne, give type of a~c t, identification n1unber, altitude, heading, speed, L~d home station. TINE AND DATE OF SIGHTING: (1) Zulu time-date group of siehting_,:1L >/1 .. ~ \ ' (2) Li~ht conditions. (Use one of the follolr>:ing terms: night, :.~y, dawn, dusk.) --- e. LOCATION OF OBSERVER(s). Give eY~ct latitude and longitude of e~ch observer, and/or geographical positiono f. IDENTL"G'YING INFORI~1ATION ON OBSERVER(s): (1) Civilian -Name, age, mailing address, occupation, and esti?~te or reliabili (2) ~alitar7 -Name, grade, organization~ duty and estimate of reliability. ADC-1 Cmbt Spt Gp-CDC Belftidge AFB~ Micho U.S. AIR FORCE TECHNICAL INFORMATION T h i!. questionnaire has been prepared so that you con give the U.S. Air Force as much ion os possible concerning the unidentified aerial phenomenon that you h~ve observed. Plecse try to answer as many questions as you possibly con. The information that you give will be used for research purposes. Your name wi II not be used in connect ion with any statements, cone lw s i~ns, or pub I ications without your permission. We request this persona I information so t hat ir i t is deemed necessary, we may contact you for further details. 1. When did 'I:;.; see the object? (Circle One): 3. T ir!' e Zone: (Circle One)( a . t s_t_ern .. ' 1>:-C:entrOl c. Mour.tc i n (Circle One): a_. _ P.aylight Saving d. Pacific 4 . Where were y ou when you sow t he o~;ect? Neores,. ? ostol Address City or Town Stote o r County 5. ho..,., Ions ..,.,os ~bject in sight? (To-:~1 Duration) \ ~. Fairly certain ) c. Not very sure d. Just a guess Minutes Seconds 5.2 Was ob;e~ h ; i ; ht c ontinuous !,-? 6. What was t he : ond i ri on of the sky? a. Bright#-,.; 7. IF you sow the object during DAYLIGHT, where was the SUN located as you looke d 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 Thia form a uperaed&:t F m 164, jul 61, whic h i a obsoleh!. ~. IF you saw the object at NIGHT, what did y o u notice concerning the 5TARS und MOON? 8.1 STARS (Circle One): '--..:.a-~:J5n,_t .. remember 8.2 MOON (Circle One): Bright moonlight Dull moonlight No moon I ight -pitch. dark Don't remember 9. .-hot were th e weather conditions at the time you saw the object? C L O UCS t Circle One): HEATHER (Circle One): a. C lecr si.:y b. Fog, mist, or I i gh t ra in c. Scot !.e d clouds Moderate or heavy rain d. Thic~ o rheavy clouds d. Snow e. Don't remember f 10 . The obje:t appeared: (Circle One): (_ d. A s a light ' -.. -c. o~r. 't remember c . S:>lid ll. It it a~r: e-:r'!d as a light, was c . 3righter o. ::>immer it brig~ter than the bri9htest stars? C...: A~ou,!. the ~ame d. 0'6n't know 11. i Ccr~-:J!'~ br ightness to s o me ~ommon object: (Circle One): 13. Did the o bj e ct: (Circle One fo r eoch question) Don't know