2. LOCA liON 'ri'l. o:= C ;sERVATION ?. f'r1\ SIC;,_ EV .DENCE U.S. AIR FORCE T ECHNICAL INFORMATION -"1 s questionnaire has been preparod :;o that you can give tho U.S. Air Force as much ni: ... n as possible concerning the unidentified oorial phenom,.non that you hove obo;ervc d . o : e.: : ty to a nswe r as many questions as you possibly can. Tho information that you giva will c.~ ~ :~ fo r research purposes. Your nome will not be used in connect ion with any stot~m~nts, c-,rc ion'i, or publications without your permission. We request this p ersonal informat io n s o ~: :: : : i s deemed necesso;y we may contac t you f o r fur ther details. l. When did} -::u sec the obj"!ct ? 2. T i me of day: (Circle One): A.M. or Month Y !' o: 3. Timc"lc e (Ctrclc One):( o. cos:ern b. Cen r.:l c. Q l,cr (Circle Orc}: a. Daylif,ht Saving tb.-St a ndard ~t::e we , ~u wpen you sow t he o!>le:::t? ,,.... Posta l Acldrcs:; City or Town Stole or County :-:::'1 .... s o b1oct in sig!-Jt? (io:l Dur ation) :: . c~rtoin 1:. :=or ly certain c . ~lot very sure d. J ust a g uess Minute:; Soc o nds 7 . IF you s :.w r-:: ~h'cc.t during DAYLIGIIT, where YO'i the SUN loca ted or, y o u looked ot the objf!ct? ( Circl One1: "' In front o f you b. In hcc.k of yvu c. Toyourrighl d . T o y our left c . Qvcd1ec.d f. Oo n ' t rt: m .. mbN 8. IF you sow th .. obje c t at NIGHT, what did y ou notice concerning tho ST ARS ond MOON? STARS (C:-:~ Onu): 8.2 MOON (Circle One): Bright moonlight Du ll moonlight No moonlight -pitch dark c~ r ~IT'emb<!lr Don' t remember 9. What W':!t: ' t .. ~o~her condition:; at r'12 time y ov saw tho object? CLOUDS (C : : One): WEATHER (Circle One): a. Clear s '<)' b. Fog, mist, o r l ight rain c. Moderate or heavy rain c!. Thic~ o ~ :.vy c louds e . Don't romomb"r 'c.J ~oiid d. A! c l i9h t 11. li' it o::'Je::r~':! ::; o 'fight, was it brig"l :! t~on the brightest -:;tors? (Circle One): o. d ;'tcr c. About the some d. Don't know 11.1 C or:-p:t" ::r~;htn~S!i to some co--~., object : or blu:r .. (Crrclc One for coch qu~stion} Appoor I . : :~d sri II ot a ny t in"e? b. 5 ddedv <..;>-: d \.P and rush awo l a t ony tim'!? Yc!i No < u~ -~ :::ot:s or e xp lortc ? Yes Don't know d. G11ecF~m .<.~? Yos , No Don't know t! . Chol"g~ c gr.-~ss? Yc~ No Don't know Don't know Flash or fl On t l<nOW D i :;nppc or cmd r>lo ppcar? ltl. Did the o!:> ,-:; disoppoor while you were wa tc hing it? If so, how? .: ::t move behi01d sorr.elning o t any time, pcrticulorly a c loud? Don' t KnoN. it~-:. :l bahind: IF y o u answdrod YES, th~n t u II wh ut 16. O'j t :: c -:-ct move in front of :.c~e~hing at on) t ime, pa r ticularly o c loJd? Don ' t Know. IF y ou answorE:d YES, thl!n r~ll whl: ew words tho fo ll owin;; ~-;,,fis abnut the o!>ject : ;.'\,.~r. -;:: 'i! o!:ljoct is covered cy nood of tho motch. If you hod performed this cxp'!riment at ,;,P. tirr.c of th:: ' :. i rl. i:tg, :.. :.., nuch of the obje: "" ':1 hove l.ccn covered by t he match head? . 19. ~--~::. :.-, -: Nill sl,~,-... .,~ 5"-:::= o f th _ obj c t or ol:.,ccts. Lahol oul includ~ in your sbtch cny detcil~ o -~ :: ... ---~ :>J sow su:' -:::. --;~, protrusions, etc., and c:.peciolly cxltoust trails o r vapor tr11ils . Xl. Do you think >~J con estimate the speed of the object? IF y.1u o.:~.,..e~d ; ES, 'hen '"hat speed would you estirnute? Oo y~ .:.. -t. - _ -:Jn e s I imntc h o w fer away fr om you the obJ"':Ct wo s? Crh '-'(ES, then h o w fo r c"'oy would you soy it was? 'i,. err-W" ' ' )>:' ocotcd when you sow he object? 23. \'/ere you (Circle One) o. In the bvsines!: section of o city\~.'" "b. In the resi Juntiol section of o clty? c . In op"n countrystde? d . I lear on oirfu::lcl? c. rlyng ov~: a cty? f. Flying o'c: op..:n co;.~ntry? e l imo, then complete the folloHin3 quc:~ton~: '!M'! d!~:un were you moving? f. Southwest mile s p~r hour. 21.3 D :l y:-,o,; :" ., o t any tim~ ,.,.hi lc y:.o... ... er!! looking ot the ob1ect? h. Northwest 13inoculorc; Yes No Tnleseo;')'l Yes No Theodolite Yes No In c:rJc: thot y~w 'as clear a p=cturc cs pos'>ibl. of what yov ::ov, c!o!.cribe in your own "orJs n common whn p laced up in the skj, would g ive tho saml! appcaronc: o:; :he object whi~h ~uu sow . 27. In t he following sketch, imagine t hot you ore ot the point shown. Ploco o n "A" on the curved l ine to show ho"' high t he o!:>j~ct wos above the horizon {skyline) when you firs t s ow it. Plac e o " B " on t h e sam~ curved lme to s ltow h ow 1-i3h the object wos above the horizon {skyline) when you los t !>ow it. P lace an "A" on tho compass when yo ... '1/S: so w it. Place o "B" on the compass where y ou la s t sow the o b je ct. vr . 0;; _;ve that will show tne m::>liO:i t hat the obj.:c t o r ob ject s modo. Place on "A'' ot th~ beginning o f th~ pel., o ' :! ' ' ot the e nd of the poth, O!"'C show a ny changes in d irection d ur ing the course. J Do ... c: -: ':.~ :i ;,ow they were ::: ;~d, on.:f pu t on arrow t o show the d ire c t ion th~t the y we re t raveling. 30. Hov~ you ever !>cen this, or a similar object before. If so give date or dotes and location. j 31. Was o;~oe A !'..~with you at th e time you sow the object? (Circle One) 31.1 1= y : u ::-!;wered YES, did t hey see the object too? (Circle One) d a dd resses: I 32. p:ca:.e gi11.: e follo.ving information cbout yourself: City Zone State tnd:c_,r~ .:~. -:: : enol info rmation ot:.. )'Ourself, including any special expe rience, which might be pertin.:nt. 33 . Whe n ond t o . .._.1,:,.-d :; you re port that you hod sc~n the object? D o y Morot h Y o o r 34. Date you completed this questionnaire: 35. lnformotio:1 w~kh ) ' OU feel pertinent and which is not adequately covered in the specific points of t he qucstioni'.:!. ~ ':lr a narrative explanation of your sighting. II EPLY TO DEPA~TMENT or-TH~ AIR rO,:tC:!:: H E AOOUARTEPU FO~EIGN TECHNOLOGY OIVI~"liO~I l;t.f"!\C) WRIG H TPA TTER!SO N A I it FOI'IC DA.aZ. OH 10 A .J.A.J.J u:-_serva on ' -p r ?~ -?:-ence y(,ur uni de:1ti fied oboervation. The i nformation vnJ ch ;.~ ::ave received is ;.ot suffic1 ~nt for a scientific evaluat.i on . est you complete t:'\e attached FTD Fo:c"lJ\ 164 and r etur n 1 t i n 1.!" .. envelope provlj-=~ Tnan.\: you for reporting your observation ~: ~he Air Force. .:.-.35 C . HANATI', Colc~el, USAF : :: tor of Technol :~ ~;.:! SubsysteiT'.s F':'D Forw 164 w /envelop'! U.S. AIR FORCE TECHNICAl. INFORMATI01>! Th ' questionnaire hasa been proparod 10 tha t you can y ivo the U. S. Air Force aa much infor'"'1~''::>, os pouiblo concerning tha unidentified ao1rol phanoaneno11 th a t yo u hnvo oLIIorvtu i . P loou ,,.. to answer as many questions aa you pt's::ibly can. Tho information that )r<: u g;vlt will bt ~s,.,:: 'or reuorc h purposu. Your namtt will not be used in connec.ti on with any st~temeni:J, cor:. .. :.ons , or publications without your permissior.. We re quest this personal Information 11c thot ; ' is d~emad necessary, we may contac t you for furthor dettails . Whon did : v s&o t ha objec t ? 'i. Time of tiu , . Mi n 11lot11 ( Crc/o One): A.M. o r 3. T ira Zol'$ (Circle One): fa: 'b-. Control c. Movntoin d. Pocif;~ 4. 'Pfh ~re wer~ :;.v when you s aw t he o!:>j&ct? //J ,.j rtAlu .S./7 Nto" ' ' ?otol Addr C it)' or T own 5. How lct'l; ... .,, :!ljoct i n alght? ( To:: D~o~rotlon) How a Ml n~o~l 1 Se c on~ a ::. C,.toin ~. Fc~rly certa in c. Not vary sure d. Just o guess b. C I::-.Jdy Ca. Bright 'i'. Cloudy IF y ou Hrw 1' ~r o:, " c t during DAYLIGHT, whor., woa th~ SUN locot"d os y ou loc-l<eJ c! tlttl ol: 1::t? ( C lrcle One): c . In front of you b . lr. bock of you To your r icht d. T o your lflft e. Overhead f. Don't re member FTD OCT 6l 164 Thl e lorm eupe n.td I"Tn 16 4 , j u t 61, whlc:h lo ohonlo l f' 8. IF ynu !.ow the obJ&<:I ot Nll;IH, what did yOY noltc.& concerning tha STARS and MOON? 8.2 MOON (C.~rc/o One): Br.ght mooolrght b. Dull moonlight "' : ... ,., ~No moonlight -p itch dark D:>n'l rememb.r Don't romemb.r 9. Wha t ... r:-. ' ~eother c ond.t iooa ot tho tim you aow the o bjetct? CLOUDS C.r, loOne): WEATHER (Circlo One): h. fog, mst, Of J,".nr roll c. Scolle .-.:lov.t\ c. Modttroto or heavy rain o. Don't romombot 10. T ne ob1H r o.~ppelrod: (Circle One). @; A s ;: light o . Don't romember d o & a light, wa& it bti:;htor than the bright,ut sta r'? (Circlo on.,): c. About the same d . Don't know 11.1 Cor.oo'? bt ightneu to aome com,on obl$ct : ~ Sharply ovtl:.,.:: o. App r : .::nd still o t ony ti~? b. Sudd nlt ,~ .... .,.e up ond rulh ow~ ot any tim~? c. Breolt .J;. .r o porta or O:(plode? e , Chano-& !::Jo, ;tHneu? g. FloahO((lidor? h. DaopJ)-'Jor 0'1d reappear? {Circf., Ontt for ocx:h qunHon) } s;s: No Don' t know J > Don' t know Yea Don't know Yo., Don't !tnow o, Dcn't know Don ' t know Don't lcnow Don' t know