l. D A ;F TIME GROUP 2. LOCATIOl't --. l Ci vilia."l ! t. Ni.lr ~ P.E R OF OBJECTS LENGTH OF OBSERVATION j (.': 1 YPE OF ORSERVA TION G:-o ur..d-Vis 1a 1 s 7. COURSE ~ .. ~tiCTOS \ 9 . ,.tiYSICAL EVIDENCE As-;ro (I3T~Oa) 11. BRIEF SUMMARY AND ANALYSIS Object lras t:hite al:vu.:.;, liA a star. Object was wllet except for the vapor t~ci.l. Object disa.p~ared alr.iost immedis.Dly. fTD SEP 63 0-329 (TOE} PreviJua edlUona ol thlafonA =~ be \iuci. 3~. Date you completed this questionnaire: 35. lnforntation which you f .. l pertinent and which is not adequately covered in the specific points of the questionnaire or a narrative explanation of your sighting. TDF:r/r.JFO DE~A .. TMKNT Ofl' THK AI" P"O"CE HKADQUAitTKIId I'OfltKION TKCHNOLOQY DIVISION ( Af'eC) W"IOHT-~ATTIIt80N AIR I'OIICI 8Aa OHIO s3a UFO Observation Reference Y'~r 'ID1dentit1e4 observation. The information which we have received is not autt1c1ent tor a scientific evaluation. Request you complete the attachecl F'TD Form 164 and return 1 t in the envelope provided. Thank you for reporting your observation to the Air Force. ( . S C. MANA'rr Colonel, USAF pirector of Technology and Subsystems F'l'D Forna 164 w/envelope U.S. AIR FORCE TECHNICAL INFORMATION 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 ,ossibly can. The information that you give will be used for research purposes. Your name will DOt be used in connection with any statements, conclusions, or publications without your permission. We request this personal lnforrnation so that if it is dHmecl necessary, we may contact you for further details. When did you see the obiect? 2. Time of day: Hour Minutes. Month Year 3. Time Zone: (Circle One): {a':) Eastern b. Central c. Mountain d. Pacific 4. Where were you when you saw the obiect? 5. How long was object in sight? (Total Duration) a. Certain @Fairly certain (Circle One): (Circle One): ).l~ Daylight Saving City or Town c. Not very sure d. Just a guess 5.2 Was obiect in sight continuously? 6. What was the condition of the sky? 7. IF you saw the obiect during DAYLIGHT, where was the SUN located as you looked at the obiect? (Circle One): FTD OCT 62 164 o. In front of you b. In bode of you d. To your left e. Overhead c. To your right f. Dt')n't r emember Thi fOf'lll ..,..,.d PTD 164, Jul 61, which l obolete. 8. IF you saw the obiect at NIGHT, what did you notice conceming the STARS and MOON? 8.1 STARS (Circle One): @ Don't remecnMr 8.2 MOON (Circle One): a. Bright moon I ight (i> Dull moon I ight c. No moonliiJht-pitch dark d. Don't remember 9. What were the conditions at the thfte you saw the obiect? CLOUDS (Circle One): WEATHER (Circle One): Q Clear sky b. Fog, mist, or I ight rain c. Scattered clouds c. Moderate or heavy rain d. Thick or heavy clouds d. Snow e. Don't remember 10. The object appeared: (Circle One): b. Transparent @ As a light e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): a. Brighter c. About the same Don't know 11.1 Compare brightness to some common obieet: 12. The edges of the object were: (Circle One): a Fuzzy or blurred Like a bright star c. Sharply outlined d. Don't remember 13. Did the obiect: a. Appear to stand still at any time? b. Suddenly speed up and rush away at any time? c. Break up into parts or explatfe? d. Give off smoke? e. Change brightness? f. Change shape? g. Flash or flicker? h. Oi..iappeor and reoppear? (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 Don't !mow 14. Did the obiect disappear while you were watching it? If so, how? 15. Did the obiect move behind something at any time, particularly a cloud? (Circle One): Yes Don't Know. IF you answered YES, then tell what 16. Did the obiect mew in front of something at any time, particularly a cloud? (Circle One): Yes. @ Don't Know. IF you answered YES, then tell what 17 . Tell in a few words the following things about the obiect: We wish to know the angular size. Hold a match stick at arm's length in line with a known obiect and note how much of the obiect is covered by the head of the match. If you had performed this experiment at the time of the sighting, how much of the object would hcrve been covered by the match head? Draw a picture that will show the shape of the obiect or objects. Label and include in your sketch any details of the obiect that you saw such as wings, protrusions, etc., and especially exhaust trails or v_ppor traris. Place an a"ow beside the drawing to show the direction the obiect was moving. f3l, L Lot.~ ex c. e .J r -rc n l'n~ VAfO ~ 20. Do you thinlc you can estimate the speed of the obiect? (Circle One) Yes G IF you answered YES, then what speed would you estimate? ------- 21. Do you thinlc you can estimate how far away from you the obiect was? (Circle One) IF you answered YES, then how far away would you say it was? --'--o=:; ,.; 22. Where were you located when you saw the obiect? (Circle One): a. Inside a building b. In a car (&)Outdoors In an airplane (type) 23. Were you (Circle One) In the business section of a city? In the residential section of a city? In open countryside? Near an 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 moving? (Circle One) n. North c. East e. South g. West Northeast d. Southeast f. Southwest h. Northwest 24.2 How fast ware you moving? miles per hour. 24.3 Did you stop at any time while you were looking at the obiect? (Circle One) Did you observe the obiect through any of the following? Eyeglasses e Binocular~ Yes Sun glasses f. Telescope c. Windshield g. Theocfol ite d. Window glass In order that you can give as clear a picture as possible of what you sow, descri~ in your own words a common obiect or obiects w ich, when placed up in the sky, would give the same appearance as the obiect which you sa In the following slcetch, hnagine that you are at the point shown. Place an" A" on the curved I ine to show how high the obiect was above the horizon (slcyline) when you lirst saw it. Place a .. 8" on the san curved line to show how high the obiect was above the horizon (slcyline) when you lost saw it. Place an "A" on the compass when you lirst saw it. Place a "8" on the compass where you lost saw the obiect. 28. Draw a picture that will show the motion that the object or objects made. Place an "A" at the beginning of the path, a "8" at the end of the path, and show any changes in direction during the course. 29. IF there was MORE THAN ONE object, then how many were there? --l r"'-------- Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.