p;~OJC:CT 10073 ~2CO~u ',/uo~llo Civili:1:1 ~:--Nl~;[R OF naJECTS ~,. LENGTH Or OBSERVATION ~ l oiuutes ~ t t.. TtPE OF OBSERVATION '1 Ground Visual Sou"th We:it-f.:orth ! SJ, PriOTOS l ?. PrlY5iCAL EVIDENCE 10. CONCLUSION IDEr.'TIFIE;) 11. BRIEF SUMMARY AND ANALYSIS SRE CASE FILE p,...,loue edlUone of thle fonD may be uaed. DEIIAitTMKNT 0~ TH. AIR P'O"C. MIEADOUA"TCite P'O"IICIN TICHNOI.OOY DtVIeiON C A'8C a WRIGHTI'ATTI"eGN AIR ,OJtCIE Ma. OHIO 418411 TDF:r/tiFO Wa.p eil.o Ul''O Observation Reference your nn14ent1t1ecl obaervatlon. 'lbe intorma'tton vh1cb we have received is not suft1c1ent for a ac1ent1t1c evaluation. Request you complete the attached F'TD 164 and return it in the envelope provided. Thank you for reporting your observation to the Air Foree. J'ftMES C. MANA'rl', Colonel, USAF rector of Technology and SUbsystem. FTD Form 164 v/envelope U.S. AIR FORCE TECHNICAL IH FORMATION This questionnaire has been preparect so that you can giYe the U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you have observed. Please tty to answer as litany questions as you possibly can. The information t~at you give will be usecl for research purposes. Your nam1 wi II Dot be usecl in connection with any statem1nts, conclusions, or publications without your permission. We request this personal inforntation so that if it is dHmecl necessary, we may contact you for further details. , 1. When did you s .. the obiect? 3. Time Zone: (Circle One): a. tastern C' Central c. Mountain d. Pacific 4. Where were you when you saw the ob iect? (Circle One): (Circle One): a. Daylight Saving <)Standard City or Town State or County 5. How long was object in sight? (Totol Duration} ,1Pfv.o I Hours Minutes Sec:onc:Jt a. Certain c. Not very sure @ Fairly certain d. Just a guess S.2 Was obiect in sight continuously? 6. What was the condition of the sky? -faJ Bright .. "6: Cloudy 7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the obiect? (Circld One): a. In front of you b. In back of you- d. Toyourleft e. Qverhe~ c. To your right f. Don't remember FTD OCT 62 164 Thla form au_,.,.,.,. P' Tn 164, Jul 61, whlc~ la obolete, 8. IF you sow the object ot NIGHT, what did you notice co.,ceming the STARS and MOON? 8.1 STARS (Circle One): (6'; Don't remem'-r 8.2 MOON (Circle One): a ... Bright moon I ight !~ Dull moon I ight ~ No moonlight -pitch clark d. Don't ren:ember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): g Clear slcy c. Scattered c I oucl!' cl. Thick or heavy clouds WEATHER (Circle One): b. Fog, r.:ist, ~ li;tt rain c. M eraM or eavy roen e. Don t reflle mber 10. The obiect appeared: (Circle One): b. Transparent d. As a light e. Don't remember 11. If it appeared as a light, was it brightM than the brightest stars? (Ci,.cle One): a. 9righter. c. About the sa"nf' b. Dimmer - d. Don't know 11.1 Compare brightn .. s~ to some common ob;ect: 12. Tne edges of the obiect were= (Circle One): a. Fuzzy or blurred b. Like a briyht star @ Sharply outlined d. Don't remember 13. Did the object: a. Appear ro stand still at any time? b. Suddenly speed up and rush away at any time? c. Break up into ports or explode? d. Give off smoke? e. Change brighmess? f. Change shape? g. Flash or flicker? h. Disappear and r~appeor? (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 know 14. Did the obiect disappear while you were watchinif it? If so, how? 15. Did the obiect move behind something at any time, particularly a cloud? (Circle One): Yes Dont Know. IF you answered YES, then tell what 16. Did the obiec:t mOe in front of something at any time, particularly a cloud? (Circle One): Dont Know. IF you answered YES, then tell what in front of: 17. Tell in a few words the following things about the obiect: 18. We wish to know the angular size. Hold a match stick at arm's length in line with a known obiect and note how the obiect is covered by the head of the match. If you had perfor11d this experiment at the time of the sighting, how much of the obiect would have been covered by the match head? 19. Draw a picture-that will show the shape of the obiect or obiects. Label and include in your sketch any details of the obieet that 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 obiect was mOYing. ~" J~t.l $TAtltJ.-,'-Af,llj D 0 ttell .... iv' ~f. Do you th inlc you can estimate the speed of the obiect? (Circle One) 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 an~wered YES, then how far away would you say it was? Whra were you located when you saw the obiect? (Circle One): a. Inside a building b. In a car d. In an airplane (type) 23. Were you (Circle One) a. In the business section of a city? (} In the residential section of a city? c. In open countryside? d. Near an airfield? e. Flying over a city? 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) a. North c. East b. Northeast d. Southeast f. Southwest h. Northw.st 24.2 How fast WY'ere you moving? -------miles per hour. 24.3 Did yov stop at any titne whit. you were loolcing at thobject? (Circla One) Yes Did you observe th., obiect through any of the following? a. Eyeglasses b. Sun glasses c. Windshield e. Binoculars Yes ~ f. Telescope Yes {fi.o .. g. Theodolite Yes {N} d. Window glass In order that you can give as clear a picture as possible of what you saw, describe in your own words a common obiect or obiects which, when placed up in the sky, would give the same appearance as the obiect which you saw. 27. In th following slcetch, imagine that you are at the point shown. Place an "A" on the curved I ine to show how high the obiect was abcwe the horizon (slcyline) when you lint saw it. Place a "8" on the san:e curved line to show how high the obiect was above the horizon (slcyline) when you last saw it. Place an "A" on the compass you lirst saw it. Place a "8" on the compass where you last saw the obiect. 29. IF therw was MORE THAN ONE obiect, then how ntany were there?-----'------- Draw a picture of how they were arranged, and put an arrow to show the direction that they were trawling 30. Have you ever seen this, or a simi lor obiect before. If so give date or dates and location. 31. Was anyone else with you at the time you saw the object? (Circle One) Yes 31.1 IF you answered YES, did they see the obiect too? (Circle One) 31.2 Please list their names and addresses: 32. Please give the following information about yourself: Middle Name TELEPHONE NUMBER ------- Indicate any additional information about yourself, including any special experience, which might be pertinent. When and to whom did you report that you had seen the object? 2 2-,Af ltlfZ A)o ci-.f{ce4L &a...r ~4de. VAIL y /J D t11 j eo /f.t eNk"' C,Z Day Month Year 34. Date you completed this questionnaire: Month Yeer 35. I ian which you f .. l peatlnent and which is not adequately covered in the specific points of the questionnaire fit a explanation of your sighting.