10. CQ;'\CLUSION 1''f?E OF OoSE~VA710N 11. BRI ~ f SUMMARY AND ANALYSlS 3Q. Have yeu ever n this, 01 a aimi lor obiect before. If ao give date or dote and locoUon 31. Was anyC)r.e elae with you at Itt~ time you saw the obiect? (Circle One) 31.1 IF y~ onawered YES, clid thy the obiect too? (Circle One) 31.2 PI,.. liat their name 1nd oddreaaet: 32. P!cut ;:~the following lnfmatlon about younelf: TELEPH~: NUMBER-------- 33. When o~ to wh ~ cfld yaY repert that you hod aoan the obict? 34. Dote you completed this questionnaire: ' 35. Information which y04J feel pertinent and which Ia not adquately covered in the apeclflc polntl of th queatlonnolre 04' o narrative explanation of your alghtlng. DEPARTMENT OF THE AIR FORCE HEADQUA .. TERS trORiriGN TECHNOLOGY DIVISION ( AtrSC) WRIGHT.PATTERSON Alft trO .. CE BASS. OHIO 4!5433 UFO Observation , 26 Feb 67 Refer ence your unidentified observation. The information which w~ e received is not sufficient for a scientific evaluation. Re~1.-=st you complete the attached FTD Form 164 and r eturn it in the e:1ve lope provided . Tha.nk you for reporting your observation :~2 Air Force. Di:re::tor MANATT, Colonel, USAF of Technology and Subsystems FTD Form 164 w/enve l ope U.S. AIR FORCE TECHNICAl. IHFORMATIO'i Thi questionnaire haa been prepared so that you can yive the u.s. Air Force 01 much informot ion os possible concerning the unidentified ooriol phenonenon that you hravu oLnerveri. Plea f:-y to answer os many questions as you possibly can. Tho information that yc:u ~iva wilt b usd tOf rarch purposes. Your name will not be used in conna~tion with any st'ltenteni:J, con-:ks i~nt, or publications without your permission. We request this personal Information 1e that 1f it is deemed necessary, we may contact you for further details. 1. When d 1d '7 o..: see the obiect? 3. T imt Zone! ( C lrde One):...._ a. _Eastern b. Centro! ()ne): o. Doyli\)ht ~a:inrJ , b, Sto,cford c. Mountoin d. Poci~ic City or Town 5. How lo~g ,v:s object in alght? {Tct!)l Durotlon) Minutes Secondt o. Certain c. Not very sure b. ;:~;rly certain d. Just o guess 5.2 Wo1 ob:~: -s i g;,t contil'\UO~IIy'? o. Sr ight ' a. Bright 7. IF you aaw the object during DAYLIGHT, whare woa the SUN located as you loC~k~d a! tho ol:ie.~t7 (Citcle One): o, In front of you b. In bock of vou c. To your rl"'t d. To your left e. Overhead f. Don't remember FTD OCT 62 164 Thle fwM euper .. du PTD 164 Jul 61, which la ohenlet 8.-IF yn" sow thC) obtect ot NIGttl, what did you notec.e ~onceming the STARS and MOON? 8.1 S 1 AJ<f., ( C rrcle One): d. Oont remember 8. 2 MOON (C. ire /e One): Bright moonleght Dull moonlight No moonlight -pltch darlc Don't remember 9. What "'"'~ tne ...... other condetions at the time you saw the obiect? CLOUDS' C~rde One): a. C lenr slty c. Scatte: ': :lc>v,h d. Th I< I! '~ h ~hl'" y c buch WEATHER (Circle One): ~. f'og, mast, 0t leuht ro'" c. Moderote or hea-,y rain e. Don't remember 10. Tha obj~t<l ~?pe~red: (Circle One). b, f n1n s p o e n T 11. If it a~p&:lr~ os a light, waa it brignhr than the brighteat stan? (Circl& One}: a . c : i vhter c. About the same d. oont know 11.1 Com~o' btightneas to tome common oblect: 12. The edQfts ~f tr-t object were: h . . Like a bri~t t tet c Sharply outlined c. Don't remember Did the ob; ~-=: (Circlo One f01 each quation) Appear t., s tond ati II ot any till'le? Don't ~now b. Suddtmfy tp.&&d up and rush away at any time? Don't know Break up anto porta or explode? Don't know d. Ge11e off smoke? Don't lcnow Chang brig,tneaa? Don't lcnow Change ahape? oont know flash or fliclcer? Don't ~now Oaaappear and reapp&ar? Yea Don't know 14. Did the obiect disappear while you wt:r~ .,otching tt? fl so, how? 15. Did the obi~ct mo\le behind !:iOmBthtng o t ony time, particul\lrly o cloud'? No Don't Know. it moved ~hind: 16. Did the obj6::t move in front of {.;Rmerh1ng at any tame, p orticulorly a cloLJd? No Oon' t Know. Yes 17. Tel! in o f~w words the following thing~ about the obicct: 18. We -.i~h to ~ .... :w the angular size. ~.J~d a match stick at orm~ length in line with o known object anc:l1<r/; j lt mu~h of t ~=;ct is covered by th~ he~d of the match. If you had purformeJ this ex~erimcnt c.t thE~ t i.v: ..t L~ sight in ~ hew ::'I=JC:h of the ob4ect wo ... ! ~ hove been covered by the match head? 19. Draw a p ic t u!l t "'\ ::~ w i II show the ~!-tc:.~ of the object or object&. Label and include in y our 1ketch any dett~;li of tha ob j !tei ':'r.c ou s~w suc h os wi.~gs, protrua;ions, etc., and especially exhaust trails or vapor trails. Place an or!'~""' ::-e:s .:!~ the drowin~ t o show the direc.tion the obiect was moving. 27.-In th followl"t alcetch, lmotlrte thot you ore at th polnt tho"'" Place "" ''J.." on J.. r.vrv~ I me, to how ho..., hlg!, the oblect woa obcwe the horlaon (alcyllne) when yc-u first a ow lt. P loct 'l .. 8" on the 1:1rne cur.,ctd line 1C"- ahow how high the object woa above the horizon (slcylln) when ynu last ""wit. Ploco un ~. on the 'ompoa wh.n you llfJt aow It, Ploce a "B" on the compoat where you lost 1e1w ohiect. 1 ::s . . :.r~w ~ ;?krvr that will ahow the rnoti~n rhot the abiect or obiects ma~o. Ploco on A ' ar tho b3ginui:'\R of ihe ? h~ o ' B n :t th~ end of the path, Ql"d show any changes in direction during tho ~O\Jt&o, 29. IF tn~H wot .\oe~: THAN ON! obl~t, thn how rnany were there? ------------ Crow o ~i !.l~t h~w they were orr d, ond put on crrow to show tha direction that thoy w~re trovclin~ 30. Howe yeu ewer '''" thia, or a simi lor obiect befor. If eo give dote or dote a ond location. 31. Was anyo,.,. It with you at tt.e time you saw the abiect? (Circle One) 31.1 IF y~ answered YES, did they the obiect too? (Circle One) 31.2 Plw list their namet end oddr: 32. Pleote g !Y the following lnfn10tlcm about younelf: ,lr1t Name TELEPHONE NUMBER------- t"dlc~r ~,.'1 ~ddltl~ol infordtlo~ cbout youralf, Including a.,y tpeclol exparltnc, which might b. perth'fnf. 33. When and to wh~" did you reJ*t that you hod n th~ oblect? 27; In the following a Ieetch, I mot ln. thot you ore at the po,nt aho~m. Plac un /..'' on , .... r:urv! I'"" to a how ho"" high the olttect woe altove the h"cwl1on (kyll") when yeN llr1t 1aw lt. Place t.1 "8 .. un the 1.1me cur~d lhw 1C' ahow how high the obiect wos above the horizon (1lcyllna) when ynu last !tuw it. Place .1n .,,.,,,on the c.ompt~st when you ,,,., aow lt. Place o "B" on the comp111 whr you lot aaw ohtc:t. ! 23 . Dr a'-' e ~ k~:..r' that will 1how the mot ion that the object or obi acts mado. Ploc& on "A ' at thfl boginni:1g ot' ~ho ' ;. oth, o "S" ~ the end of the path, ~nd Jhow any changes in direction during tha -:otJr&e. 29. IF tnr woa MC~e THAN ONe oblc:t thn how many wr thr? --- Draw ~ pl:tur ~f ~QW thy wrt orr~n9o, ond put on orrow to 1how the dir"ction that they wortt trovuling