I TIt-i.E G~OU? " ;"~lr~2-ER OF OBJECTS 10. CONCLUSION . . ';, LENGTH OF OBSERVATION 1 'fPE OF OnSERVATION :!J. PHOTOS PtiYSICAL EVIDENCE 11. BRIEF SUMMARY AND AN""LYS:!. rpe,. ~pa s tc. ve(l. Objcc~ 'tro.s hiC.O.e;:l ;:;y ;.;c::-.e Oo~ect v a s a ori~:..-r. ;.('cO.. Prevloua editiona o( tni f orm m<ly ~-uie<!. j 30. Hove you ever seen this, or a simi lor object before. If so give dote or dotes and location. 31. Was anyone else with you at the time you saw the object? (Circle One) 31.1 IF you answered YES, did they see the object too? (Circle One) No 31.2 Please list their names and addresses 32. Please giv~ the following information about yourself: T:: LE PHONE NUMB tndicate ony 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?rtf}.'l r Day Month Year 0 '.-I 1 6 APRIL 1967 sJOBTllGS Apr \l.eYitt , New York \DeaYille, _ ' Fairplay, Colorado 1 "''Uaoii~ AI- 'Soutb Well oa. Te.U 2 'hlla, ~lYaia a "S..-a,Oe lfwDia 3 Cc.lai'~.Sprlap, ~olorado 4 . ,,.uaeola . ... llorida ~ 4 '~ Olaio 4 'Hatboro. Puurl 4 -"Ba)'enille, ltorib iu 4 'Wh8el~ v .. t Ylr81a1a 4 ~DaJtoa, 4 . ' Villap, 4 . \St J'oaepb, .5 , Color 5 ~taiaiater, Col~ 5 ~014 Briclaa, Hew 1en~ 'l*aTG', Celon4o ~il Obio 'DeaTer, Coloraclo Ml1 t iple (PHOTOS) St Other (CONJ'LICTINO Rloto a other (rOJmiCB MA.T 1'&R SfJ'ICJtr ING '1'0 NBO-. INSUF!'IC IBN'1' JTIC13Nf DATA 0t her ( PSYCB'l' ,QG ICAt,) Siptlqt O.t.r (BO~) Ektoto a Otber (SMAJJ. MW INSUIPICDH'r DATA .Aa~ro ( vBNJS) Aatre (u.B) Aa'ro (nriB) lNSOHICDlfr DATA Aatro (S ) Otber (COJIJI,IC"fiiG DA~I.) INSUi'IICliJtt DATI. . IN90HICDlft' DATA Aatro (VUUS) INSUJ*PICIDT DATA Sigbtiqt Otb (Cartn.ICTI!G Photo a ,.,.,.DI'r DATA I . Aatro ) I INSDJTIC lilft D~A I utro ( vmus) ; Rev York, lfw York 'Walcott, Iowa fSeattle, Waablactoa Oak LavJa, 1111D01a Iowa lalla, lc.a 'Cialoa Ana Clabztl4p, Cillo .!Utloa, New York ftRoobeater. Hew Yon tSt CJ10lz ~alla, Via GreeD 164, lt.teor Soo, Bepon 34. Date you c:ompleted this qu U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force a s much information as possible concerning the unidentified aerial phenomenon that you have obierved. try to an!lwer 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 reqvest this personal information so if it is deemed necessary, we may contact you for further details. 1. When d id you see the object? (Circle One): 3. Time Zone: c. Mountain d. Pacific (Circie On&): ~ ~aJ.Ii ht Saving . tandar 4. Where were you when you ~n~ 5. How long was object in sight? {Total Duration) Hours Minutes Seconds a . Certain c. Not very sure d . Just a guess 5.2 Was object in sig ht continuously? 6. What was the condition of the sky? b . Cloudy 7. IF you saw the o b ject during DAYLIGHT, where was the SUN loc"ted o; you looked at the obi-=cr? (Circle One): a . In front of you d . To your left b. In back of you c. To your right f. Don't re member FTD OCT 6 2 164 Tht" for m s upersedes FTD IIH. JUIGl. which 1s obso lete. 8. IF you saw the object at NIGHT, what d id you notice concerning the STARS and MOON? 8 .1 STARS (Circle One): 8 .2 MOON ( Circle One): ~-Bright moonlight b . ull moon tg No moonlight-pitch dork d. Don't remember 9 . What were the weather conditions at the time you saw the object? CLO . leOne): WEATHER (Circle One): ~cl~arsk Ct:...-r)ry) b. Fog, mist, or light rain c. Scattered clouds c. Moderate or heavy rain or heavy clouds d. Snow e. Don't remember J;-"-~appeared: (Circle On): _ _ b: ;HJ'iifpar~nt -e. ;Don't remember 11. If it appeared as a light, ~as it brighter than the brightest stars? (Circle One): c:1righter c. About the some b . Dimmer d . Don't know 12. The edges of the object were: (Circle One): a . Fuzzy or blurred b . Like..o bright sta c. Shar ly outlined d . Don' t remember 13. Otd th e o!Jject: (Circle One fo r each question) Ap?ear ttJ stand still a t any time? Don't know b. Suddenly speed up and rush away atony time? No Don' t know c. Br.:ck up into ports or '!Xplode? Don' t know d . G ive off smoke? Oon't know e. Change brighrness? Don't know Change shape? Don't know. f lesh or flicker? Don't know h. Disappear and reappear? Don' t know Officiatu.s. i tir Fo l.S. Did the object move behind something at any time, particularly a cloud? (Circle One): Yes \...~/ Don't ~now. IF you on~wered YES, then tell wha't 16. Did the objec1 move in front of $Omething atony time, particularly a cloud? (Circle One): Yes ~ Don't know. IF you answered YES, then tell what 17. Tell in o few words the following things about the object: We wish to know the ongulor size. Ho ld a match stick at orrn's length in line with a known object and not'e how much of 1! object is covered by the head of the match. If you hod performed this experiment ot the t ime of the sig ht inQ, how rruch . the object would hove been covered by the match heed? 19. Draw a p icture that will show the shape of the object or objt:cts. label and include in your sketch any deta ils of the objec that you so w such os wings, protrusions, etc., and especially exhaust trails or vapor trails. Place on arrow beside the drowin r to show the direction the object was moving . ir Force UFO form continued ' note how much of the sighting, how much of y details of the object l W be~ide the drawing 20. Oo you think you con estimate the speed of the object? (Circle One) No IF you answered YES, then what speed would you estimate? 21. Do you think you can estimate haw for away from you the object wos? (Circle One) 6!} No IF you answered YES, then how far away would you say It wos?_+/-"'"h_ 22. Where were you located when you saw the object? 23. Were you (Circle One) (Circle One): a . In the business section of a city? a . Inside a building b . In the re~identiol section of a city? b . In a cor c( Outdoors c. In open countryside? d . Near an airfield? d. In on airplane (type) 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) d. Southeast f . Southwest 24.2 How fast were you moving? miles per hour. 24.3 Did you stop of ony time while you were looking at the object? (Circle One) Yes 25. Did you observe the object through any of the following? b . Sun glosses Yes No c. Windshield d . Windrr gloss e. Bino~:ulars Yes f. Telescope Yes No g. Theodolit~ !\ Yes No 26. In ord<r that you con give as~ear a picture as pos!lible of what you sow, describe in your own words a common object o r ob- jects which, when placed up in the sky, would give the same appearance os the object which you sow. OffiCial U.S. Air Fore~ 27. In the following sketch, imagine that you are at the point shown. Place an "A" on the curved line to show how high the object was above the horizon (skyline) when you first saw it. Place a " 8" on the same curved line to show how high the object was above the horizon (skyline) when you lost sow it. Place on " A" on the compass when you First sow it. Place a "8" on the com- pass when you lost sow the object. 28. Draw a picture that will show the motion that the object or objects mode. Place an " A" at the beginning of the path, a " 8" at the end of the path, and show any cha~es in d irection during the course . 29. IF there was MORE THAN ONE object, then how many were there? _ picture of how they were arranged, and put on arrow to show the d irection that they were traveling JfFO form cont~nued 30. Have you ever seen this, oro ~imilar object b efore. If so g ive dote or dotes and location. 31. Wus anyone else w ith you at the time you saw the object? ( Circle One) 31.1 IF you answered YES, d id tl,ey see the object t~o? (Circle One) 32. Please give the following infor on about yourself: TElEPHONE NUM SEX t11 I!Jj t_ Indicate any additional informatio n about yourself, including ony special experience, which might be pertinent. Month Year Official U.S. Air Force UFc 34. Dote you completed this questionnaire: 35. Information which you fHI pertinent and which is not adequately covered in the specific points of the questionnaire or a narrative e~eplonction of your sighting. ir Force UFO form continued w how high the object high t+te obiect was ace o ''8" on the com 19 of the path, a "8" ct 1 30. Have you ever !teen thi!., or a similar object before. If so give dote or dotes ond location. 31. Wa!. anyone else with you ot the time you sow the object? (Circle One) 31.1 IF you answered YES, did they ee the object too? (Circle One ) 31.2 Please list their names and addre~!.es: 32. Please give the following information about yourself: f irst N o mt' Zone State Indicate any additional information about yourself, including any special experience, which might be pertinent. 33. When and to whom d id you report that you hod se e n the object? Day Month Yeor OEP RTM!NT O F rH::. Al~ fo'O~C:'! HEAOQUA.-T.-S ,O~I:IGN T!CHNOL.OGY DI'II510N f AF~C) WftiGHT.f'ATTI .. SON AU' f'OftCI 8ASI. OHIO 4 33 UFO Observation, 31 ~L:r o7 Cuyahoga Fall:l Reference your unidentitied observation. The information vhich we have received is not sufficient tor a scientific evaluation. Request you complete the attached FTD Form 164 and return it in the envelope provid~d. Thank you for reporting your observation to the Air Force. JAMES C. MANATr, Colonel, USAF Director of Technology and Subsystems FTD Form 164 v/envelope Officia.l U.S. Air Force. 27. In the following 'ketch, imagine that you are at the point 'hawn. Plocc on "A" an the curved line to shaw haw high the cbjctt wa' above the horizon ('kyline) when you first saw it. Place o " B'' on the some curved line to 'how how high t he object <wos above the horizon ($kyline) when you lost saw it. Place on " A " on the compa~s when you first saw it. Place a B" on lhe com- you lost sow the object. Draw a picture that will show the motion that the object or objec:1s mode. Place on " A " ot the beginning of the path, o "B" c the end of the path, and show any changes in direction during the course. IF there wos MORE THAN ONE abject, then how mony were there'? -...;/ _ Draw a picture of haw they were arranged, and put an arrow to shaw the direction that they were traveling. Official U.S. Air Forc UFO form dcd this qvestionnolre: . hich you feel pertinent ond which is not adequately covered In the specific points of the 1 ,. ~ ~ -! or o norrotive explanation of your sighting.