PROJEC7 ~C073 R2CO~D ~ t. NU,~af~ OF OBJECTS 10. CONCLUSION Possible ( Aiaca:. --;:-r) No data presented to indicate object could not hav~ b~e:1 an A/C.: c .'i. LeNGTH OF O&SERVATION 11. BRieF SUMMARY AND ANALYSIS . ~ it .. i'I'PE OF OBSERVATION Object appeared as an a.utomotive headlight. ~Jhite vd.th litlt. T:la blue light that was in the rrJ.ddle pulsated traveled fr~ SE -s:r in a stra.ieh t lin3. Observer \-ta.S youth or 11 years old. a blu;!r,:, Obj ec:;;, f"9. ~riYSICAL. EVIDeNCE FTO Sf;-6 3 0-~29 (TOE) Pr ... v&ou;a .,cUtJone of thh form awy be uJd. 30. Hove you ever 1een thla, or a similar obiect before. If ao give date or dates and location 31. Was anyone else with you at the time you saw the obiect? (Circle On) 31.1 IF you anaw.,M YES, did they SH the obiect too? (Circle One) 31.2 Please list their ftGIMa ancl oddreasea: 32. Please give the following information about yourself: Lost No te TELEPHONE NUMB t ;l Iii t Indicate any additional infornation about yourself, including any special experience, which might be pertinent. 33. When and to whom did you report that you had seen the obiect? 3. Date you completecl thia questionnaire: 35. lnforneation which you feel pertinent and which is not adequately covered in the specific points of the queationnaire or a '*""lve explanation of your sighti"t U.S. AIR FORCE TECHNICAL IHFORMATIOH 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 have observed. Please try to answer as many questions as you possibly can. The information that you give will be used for purposes. Your nav111 will not be used in connection with any statemants, conclusions, or publications without your permission. We request this personal i"forntation so that if it is d .. mect necessary, we may contact you for further details. 1. When did you s" the obiect? Hour Minutes 3. Time Zone: t:asterr:Y c. Ml)unto in d. Pacific 4. Where were you when you saw the ob iect? Nearest Pasta Adctrets 5. t1ow long was object in sight? (Total Duration) (Circle One): (Circle One). a. Do light Saving/ b. Stan ard City or Town Hours Minutes Seconds a. Certain c. Not very sure <;:b. Fairly certain_ J d. Just a guess How was time in sight determined? .. ,.:&t)..LaJ...Jt...b.C::::lQ~J:.=:'>t:J:~L----------- Was obiect in siFt continuously? 6. What was the condition of the sky? 7. IF you sow the obiect during DAYLIGHT, where was the SUN located as you looked at the object? (Circle One): a. In front of you b. Jn bac" of y04J c. To your right d. To your left e. Ove rhead f. Don't rememb.r FTD OCT 62 164 Thl , u r .. d FTn 164. Jul 61. u1ch ie obsolete. d. IF you saw the obiect at NIGHT, what did you notice concerning the ~TARS und MOON? 8.1 STAR5(Circle0ne): 8.2 MOON ((~rcle One): 9. What were the weather conditions at the time you saw the obiect? CLOUDS (Circle One}: HEATHER (Circle One): a. Clear sky b. Fog, mist, or I ight rain c. .~oderate or heavy rain c. Scattered clouds ~ d. Thick or heavy clouds d. Snow e. Don't remember 10. The obiect appeared: (Circle One): b. Transparent If it appeared as a light, was C a: Brig~terO) it brighter tnan the brightest stars? (Circle One): c. About tne same d. Don't know 11. I Compare brightness to some common obiect: . ftJy~t ' 12. The edges of the obiect were: b. Like a briy t star c. Sham,ly out I ined d. Don't remember 13. Did the obiect: a. Appear to stand sti II at any time? b. Suddenly speed up and rush away at any time? c. Break up into parts or explode? d. Give off smoke? e. Change brid1tness? f. Change shape? g. Flash or flicker? h. Disappear ond reoppeor? (Circle One for each question) Don't know Don't know Don't know Don't know Don't know Don't know Don't know o~n't know (Circle One): while you were watching it? If so. how? Yes Don't Know. IF you answered YES, then tell what 16. Did the obf.ct mo47e in front of IOtnethin at ony tim, particularly a cloud? (Circle One}: Don't Know. IF you cmsw,.cj YES, then tell what 17. Tell in a f~tw words the following things about the object: a. Sound AJ 0 S 0 U ~) D 18. We wish to know tha an~ular size. Hold a match stick at arm's length in line with a known ~ect and note how much of the obiect is covered by th head of the match. If you had performd this eqserit~:ent at the time of th sighting, how much of the ob!ect would haYe been covered l:y the match head? 19. Draw a picture that will show the shape of the obiect or obiects. Label anct include in ytNr slcetch any details of the obiect thet you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place an arrow beside the drawing to show the direction the olject was moving. / 20. Do you thlnll you can estimate the speecl of the ot,iect? (Circle One} Y ~ N~ . IF you answered YES, then what speed would you estimate? ------ Do you thlnll you can eatineate how for away fratft ytN the obiect was? (Circle One) Yes No I~ you answerecl YES, then how for away would you say it was? -------- (C ire le One): ttl:en you saw the ot,;ect? 23. Were you (Circle One) , . . . a. Inside a building . Q. In a car) c. Outdoors d. In an airplane (type) At sea In the business section of a city? In the residential section of a city? In open countryside? Near on airfield? Flying over a city? 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 mOYing? (Circle One) c. East South b. Northeast : d. Southeast f. Southwest 24.2 How fast were you moving? S 0 miles per hour .. 24.3 Did you stop at any time while you were looking at the obiect? (Circle One) Yes No Did you observe the obiect through any of the following? a. Eyeglasses b. Sun glasses c. Windshield e. Binoculars f. Telescope . g. Theodolite 11. Noethwest d. Window glass 2~. In ordef that you can gi111e as clear a picture as possibl~ of what you saw, describe in your own words o common obiect or obiec:ts which, when placed up in the slcy, would give the same appearance as the obiect wnich you saw. 27. ln 'the following slcetc:h, imagine that you are at the point shown. Place ar "A" on the curved line to show how the object was abcwe the horizon (slcyline) when you first saw it. Place a ''B" on the same curved line to show how high the obiect was above the horizon (slcyline) when you lost saw it. Place an "A" on the compass you first saw it. Place a "B .. on the compass where you last saw the ob;ect . 28. Draw a picture that will show the motion that the obiect or obiects made. Place an "A" at the beginning of the .. path, a "B" at the end of the path, and show any ch ... an'1s~n direction during the course. 29. IF there was MORE THAN ONE object, then how many were there?----------- Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling 30. Have you eYet IHn this, or a similar obiect before. If 10 give date or dates and location. 31. Was anyone else with you at the time you saw the obiect? (Circle One) 31.1 IF you answered YES, cUd they'" the obiect too? (Circle One) 32. Please ing information about yourself: Firat Name TELEPHONE NU Mid~le ,._,. Indicate any additional inforntotion about yourself, including any special experience, which might be pertinent Day Month Year I J : .) 0 l't ro . 34. Dote you co...,letM thla questionnofre: Information which you feel pertinent ond which is not adequately covered in, the. spectfic poj~a ,t.-th~ ~ queatlonnaire or ..,.i.,. planation of yovr aighti ... DIIIA"TMKNT 011' THE AIR ,.OIItCE HIADOUA.Tin I'OttiiON TIICHNOLOQY DIVtatON ( Al'eC, WlttOHT-~Atfl AIR I'OitCI ua, OHIO Maa UFO Observation , 19 ltbr:ll 1967 Reference your nn14eat1t1ecl obervation. '!be infor1nat1on which we have received ia not ~tt1c1ent tor a acientitic evaluation. Reques~ you complete the attachecl P'tD 164 and return 1 t in the envelope provided. Thank you tor reporting your observation to the Air Force. , S C. MANA'l'r Colonel, USAF mrector of Technology and &!bays FTD Form 164 v/envelope