PROJECT 10073 RECORD 20 Mar 67 21/02272J l!oss ulutf, ltJ.orida (1 witn~::.;s) " NliHBER OF OBJECTS ~. LENGTH OF OBSERVATION f.. lYPE OF OBSERVATION Ground Vi~al Southeast-l!;n5t ~l. FttOTOS 9. PHYSICAL EVIDENCE 10. CONCLUSION INSUF~.,ICIENT DATA FOR EVALUATION 11. BRIEF SUMMARY AND ANALYSIS SEE CASE FILE f TD S [ P 6 3 0329 (TOE) Prevloua edltlOfta ol th .. lorra ma7 b uud, In the following slceteh, imagine that you are at the point shown. Place or "A" on the curvM I ine to show haw high the obiect waa abo-te the horizon (skyline) when you lirs' saw it. Place a ''8'' on the some curved l;ne to ahow how high the *iect was above the horizon (alcyline) when you lost saw it. Place a" " A,. on the compass you first saw it. Place a "8" on the compass where you los' saw the object. Draw a picture that will show the motion that the obiect or obiects made. Place on "A" at the beginning of the .. path, o "B" 0t the end of the path, and show any changes in irection during thet course. 29. IF there was MORE THAN ONE obiect, then how many were there? ---------- Draw a picture of how they were arranged, anJ put an arrow to show the direction that they were traveling 30. Hove you ever aeen thla, or a similar obiect before. If so give date or date a and location. 31. Was anyone el .. with you at the time you saw the obiect? (Circle One} 31.1 IF you answered YES, did they '" the obiect too? (Circle One) 31.2 PleaM list their Miiiea ancl acldresaes: 32. Please give the following infortnation about yourself: Lost Nome Firat Nome Indicate any additional information obout yourself, including any special experience, which might be pertinent. 33. When and to whom did you report that you had seen the obiect? Month Year 34. Date you compl,ted thia questionnaire: Information which you feel pertinent and which i1 not adequately covered in th specffic polnt1 of th queationnaire or a ive explanation of your 1 ighting. TDF:r/UF'O U:F'O Observation Reference Y'fUr nD14eat1t1e4 o'bHrvatioft. '!be 1ntorat1oD vhlch we have reeei 11 not auttlc1ent tor a ec1ent1t1c eva~at1on. Request you e lete the attachetl l'tD Foza 164 and return 1 t 1D the envelope provided. you tor reporting your obaervatian to the Air Force. JAMES C. MANA'.r1' Colonel, USAF Director of Technology and Subsystem. FTD Fo1m 164 v/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 possibly can. The information that you give will be used for research purposes. Your name will not be used in connection with any statements, conclusions, or publications without your permission. We request this personal ,,formation so that if It is cl .. ...d necessary, .we tnay contact you for further details. 1. When did you ... the obiect? 3. Time Zone: (Circle One):(a. tqstem- b.-Central c. Mountain d. Poe ific 4. Where were you when you s.aw the obiect? Hour Minutes (Circle One): (Circle One):~: Nearest Postal Acldreas City or Town State or County 5. how long was obiect in sight? ( T otol Duration) Hours Minutes . (6. Certgllil c. Not very sure b. Fairly certain d. Just a guess How was tirne in si~t detet'mined? '};(ft..v,._ ~-,.;r_,. ~...._.-/~ 5.2 Was obiect in sight continuously? 6. What was th-. condition of the sky? (Q: Efr~ghD 7. IF you saw the obiect during DAYLIGHT, where was the SUN located as you loolced at the obiect? (Circle Onej; o. In front of you b. In baclc of you c. To your right d. To your left e. Overhead f. Don't remember Thle for ..... r.d Fm 164, Ju1 61, which ie obeolete. ~. IF you sow the object at NIGHT, what dicf you notice concerni"9 the ~TAkS llnd MOON? 8.1 STAR5 (Circle One}: 8.2 MOON (Circle One): a. Bright moon I igh"t) b. Du moon ig t c. No moonlight -pitch darlc on t remember d. Don't remember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): WEATHER (Circle One): lear skY) b. Fog, mist, or light rain c. Scattered clouds c. .~oderote or heavy rain Thick or heavy clouds e Don't remember 10. The object appeared: (Circle One): a. Sol; ....... d. As a light b. ran sparent e. Don't remember 11. tf it appeared as a light, wus it brighter than the brightest stars? (Circle One): Ca. -B;ighte!) c. About the same d. Don't know 11.1 Compare brightness to some common object: 12. The edges of the obiect were: (Circle One): a. Fuzzy or blurred b. Like a bri~ t star d. Don't remember 13. Did the object: 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 bri~tness? f. Change shape? g. Flash or f l icker? h. -Di s:.1p~ar and reoppeor? (Circle On~ f()r each question) Don't know Don't know Don't know Don't know Don!t know Don't know Don't kno~ Don'~ know 15. Old the abifN:t lito W.inf some~ing at any tilfle, partic:ul!'rly a cloud? (Circle One): it mOed bet. hM: Don't Know. IF you answered YES, then tell wh'at 16. Did th obittet ma"e in *'ont of something at any '""'"' particularly a cloud? Don't l(now. IF you answrecJ YES, then tell what 17. Tell in a f~tw wards the following things about the obiec:t: 18. We wish to lcnow the angular siztt. Hold a match stick at arm's length in line with a lcnown o&;ect and note how much of the obiect is covered bv the head of the match. If you hod perfcwffled this ex"e"iment at the time of the sighting, how much of the obiec:t would have been covered by the match heod? Draw a picture that will show the shape of the obiect or obiects. Label and include in your sketch any details of the obiect that you saw such as wings, protrusions, etc:., and especially exhaust trails or vapor trails. Place an a"ow beside the drawing to show the direction the obiect was moving. 20. Do you thinlc you ccm estimate the speecl of the obiect? (Circle One} YES, then what speed would you estimate? Stn./D t'1{J h 21. Do you thinlc you can eatiliiate how far away from you the obiect was? (Circle One J {JJj) No IF y~ answered YES, then how far away would you soy it was?~- m!J,, 22. Where were you l~atad when you saw the obiect? 23. Were you (Circle One) (Circle One}: _ .. a. Inside a buildlftl a. In the business section of a city? b. In the residential section of a city? (C n open cauntrysider Cl Near an airfield? b. In a car .t$ QU~doori) . e. Flying over a city? d. In 'an airplane (type) f. 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) b. Nortlteast d. Southeast f. Southwest 24.2 How fast were you moving? .miles per hour. 24.3 Did you stop at (Circle One} time while you were loolcing at the obiect? 25. Did you observe the ot,;ec:t through any of the following? Eyeglasses Binoculars b. Sun glasses f. Telescop c. Windshield Theodolit d. Window glass h. Northwest 26. In order that you can give as deaf a picture as possible of what you saw, describe in your ow" words o co,.mon obiect or obiects which, when placed up in the slcy, would give the same appearance os the ooiect which you saw.