.C:RVATION i 1. BRIEF SlJMM; RY AND A .;ALY!il$ J_::,,fo I I R) Na .SG'.) J ) s',lv~r l bj ~ t I I 3. A p p n ho:"Jo(r~ -}o rfl y , 'l UJ cl upPF~ U.S. AIR FORCE TECHNICAL INFORMATION T'c.. ~ qu~stionnaire hos been prepared so thnt you con give the U.S. Air Force as muc h ,..,~cr-.,. - -cs possible concerning the unidentified aerial phc-noml'non that you hove observed. c ,!:: .... ., to answer or. mony ::;uestions os you possibly con. Th~ information that you givf! wdl t6 .. _ =~r research purpOS3S. Your nome will not be u~ed in connec tion with ony statements, : :r.:i_, _ns, or publications w : lhout your permission. We request this personal info r mation s o lr:: ,c i s doomed nectssory, we may contact you for furthe r details . 1. 'nh~n did J =-see the object ? Month Y~c (C~rclc 011c): fCircle One): (Circle One): o . Daylight Soviny b. Stondorcf Naout ~.,stol Address c. Not very sure d . Just o guess Stole or Covnty Minute-. Seconds 7. IF you sow e oe1 t".:t during DAYLIGHT, where wos the SUN locoted as you looked a t the object? (Circle One): ::. , front of you b. In bock of y ou To your ri gl,t d. T o your left c ) Ovc rhl'oo I. Don' t rc ml'"mbl"r b. Dull moonltgltt t;. No loiOOnlt<jht pitclo d'lrk d. Doro't oc-tuernb . .,r -wt~nthrr condtlti"JlS c th~ t ime you sow th" object ? ,, f-c,J, ,-ist, nr ltq c-. o"ft!r"'l c.IH'l'';' in t r r rr. c. Ab:>ul t hl' <;Omc 1. Don' t knC'IVI 12. The c=o:es 13. Dicl t~w ob cc: a . Ap <:wr TO: .. ':l ... d still a t untlo:T'~-; f. ChonJ'! sh::~'l O rlosh ~r fl :ker? h. o.~oppeo ~J rooppe'lr? ((rrdc-On fur cry:h ouslion) Den' t kro o w Don' t ~::1ow Don ' t know Don' ! know D:on' t know Ocm ' 1 kn~w 14. Did the obiftc t di!IODI>'tClf whi 1., you w~rft wo tchinp i t ? If s o , how? ( Yes I No Know. IF you on:sw~tred YES, then tel l whot 1/1. Dtd the O" -ct move in front of o;o..,eth il"'1 n t nny t i,.,.,, potir.ulo rl y "riNcl? Don't Know. IF y ou ono;w>~red YES. then t.~ll what 17. Tn!l i" c : ... 41 wor~" t fo!lo Yinq tl-ing; ohout th"t ohtlCt: 13. ~ wi~l. ~ <now~ .. , on!lular siz~. Hoi~ o match s tick a t a rm' s lcnpth in line with o kno.,.,n ob!~ct C'lnd not~ how mu:1 of .,;, obj~ct is covc>r~d bv rhf'l h ,. o.J of th~ match. If yc-u hod P"'rform,.d this exp.,rirn.,n t ot tho ti,.., of th~t s ig'1rin9, 1~-H mvch of th., t:'biccl .,.,,.,ulr.l hove been cov~red b., the match hend? 19. Dcw::;:: ,... a ~:lt will show r.,a s'-.:l.:~ of the object or objects. Lobel and include in your sk~tch a ny det a il s 0$ :_ .;:_ w ::; y~U SOW su::h .:!S ...,,;~,protrusions, etc , , and especially e xhaust troiJs Or vapor trails, Plc::o C"' .:; ... oe~.de the drll"f'-; ::. .>how the direction the object was moving 20: Do you thinlc you co:-. ostirnot~ t h spo~d of tho objoct? IF yov c"'~ ....... ,~d YeS, then whoi r~!td would you estimcat ,? 21. Do ye>v .:., -~ -.: ::::~ :.o~timote how !or away fro n Y-'U the ohj.cl wo'!.? IF rc ;~: ..... .,dYES, th l' n how f er owoy would you say it was? a. Ins: ~ .. Jtlding o. In t~ .... busin~:;s :.t-ction o f o city? h. In th~ rec;id~ntiol :=er.t t('n c f a ci.y? In t,JI'I c.nuntry~i d. N'"'or .n t~ir;t!)ld? e . Flyin:1 01~r c ritt? f. Flying o,,.,: r~n co Jnt'Y? Or othN venicl' Ot th.:t f t ~, th:n COITI;>I"'t It,') fofbwing quoSIIt\,,~; f. South Hoo; t milco; per hour. ~= tb followinQ? Bino-:ulors Ye!O No f. Tel"lcorc Theorlol it /6. In or~"' t;, _ -, niv..: os cl.::~r ~ ;>tclltre a~ pos:.iblr o ! who: you .,.,.~,. d~scrib- in your o,.,n words o common o',joct or c:, ~c. .. dch, when ploc~J-:! up in th" sl<y, wculd g iv,. th ">JI':"'., npp.-nronc~; os tr.~ o!:>1ect wh ich you sow. 3 0. Hovo y ou av~r 5UJ n t h is , oro simi lcr o hj:rcl b..,foru. If s o giv" J tltJ or dut ..... vnJ looti on. with you o t t h " t im..1 you ::ow th~ objec t ? (Circle One) 31.1 r= ~..:-:.uw,.>d YES, dtJ tn~y :.~o t ho o bject too? (Circlu Ono) 31.2 ? ~-=-;~list th"i' names and od:k.-i::.~s: ~t,e fo llowing informot ion ~;,ul yc..ursdf: Middl .. Nome !rd . :.- ::..y -::b.tionol infotm'J:i~!"l .,._,_ )'O'JrstIF, including a ny !ip':ciol f}X!lerit>~nco, -.wfah:h might be p.!rtin~nl. 33 . Whe., and t o .,. ~ -.-~ :,j you repor t t ho t yo u hod s et"n t hl" object ? 34. Dote you compl.,hd this questionnaire: 35. lnformoti~ Al'id'l you feel pertinent ond which i:. not adequately covero d in the specific poinh of the questionno r -x a narrative explana tio n of your sighting . Rt:PL Y TO DEPARTMENT O F rHE AIR -:-o .lCC HEAOOUAF!TER" FOlH:tGN TECHNO L.OG Y Ol'/13ION lAF.iC) WRIGHT.PATTERSON Alk F011Cti B A!JP:. OHIO A 3:l R~: :-encc y ,ur unidc:::..!.fied observation. Tne inform.'ition vhich \."" ;ave r eceived is ~ot sufficient. for a scientific eveluation. ~""'-::st. you complete ~::--.e attached FTD Form 164 nnd return it in t!-.e nvelope provl.i:::l. T'nank you for reporti ng your observation t~ ~c Air Force . HANA'IT, Colc:-:el, USAF of Teclmolci:J :. : '~ Subsystems 164 v/enve10I>C