2. LOCATION (..)j oe;:, \lao Ol'i 1:.c:: then the moon. Lit up a lart;~ o.rn~ t..~.:.'.::! .. ~1erc o';)ject wa s . Object apFCo.red to ri::;e r~pidly. o jcC\, H.:l.S \~ti've <..:ld gave o:f a re:dd.i:::;h h\W. It ap}h.::.:.lc d to l c:::tc a \r:ute t:rc.il of s mol-:13 or v .:\por. OL)ject, ap::>earod t.c .. C.::~cer:ci. and til<.:l ri~e rapidly. Object disappeared in a rr.~...,t . of a fa.-~ seconds U.S. AIR FORCE TECHNICAL INFORMATION - . :; :;.Jestionnoir" has been prepared s o that y o u con give the U.S. A ir Force a s much tr.'~-..: .:>n a s possib le concerni'1g the unidentif ie d aeria l phen, menon that you hove o b s e:ved. J:l ;e .. y t o answer as many que stions as you possibly can. The information that y o u give will b~ . ~e or researc h purposes . Your name will not b:~ used it1 connec t ion with any statements, col"':'~-.:>!'ls, o r publications without your permission. We request this personal information so th.:: i: r is deemed necessa ry, we may contac t you for further deta il s . 1. Whe n d t':!) .. _ see the object? Hour Mi nul? s (Circle One): Ocy Mon l h (C~rclc One): (Circle One): a . ~Doyli:;ht Sa v in g b. Standard Stoto o r County c. Not v e ry suru 6 . What wos t" c: .. ;:i:on of 1ne slcy? a. 13right b. Cloudy ' 7. IF you .. ow el,e cbrect during DAYLIGHT, where was the SUN located oc; you lo oked ot the o bject ? (Circle One): a. In front o f you b. In b ock of you c. T o your ri ght d. To y our left e. Overheo-i f. Don' t rcmemb~r Thl a fc>m 'IUPf'""' 1-''rn If>\, JUI 6 1, "'hie-:\ 1 o olnolelf' 8. IF y o u s o ,.. t e N>Je CI o NIGHT, what d1d y o u notic e cc .::crnmg tht> ~TJ\RS onc1 MOO~? o. Rr1gh t moonltqht b. Du II moon l1 ~1h t c . No moc-nl1ght -flllc-!1 dark c!: O on't re memher 9 . What ,..,.. "'WI'Ot h " r ::onditions o t th e ti<ne y ou c;ow t hl' o hjr-t:t ? a. C lear o; v c . Sco t:e: ::loud" d. Thtc'< c cavy :: (.C. Mod.-.r-:~ or heavy rvln ' brigh r"'!<S c. About th d. Don't know co~je~t:---, c. Othct _ ' ( Crrclc One fo r roch :tu,.st ion) Don't know Don' t know b. St.:.Jj,. s~,-:: ~till r t nn1 'ImP? S"' : ~ uo nnri ruc;l, c:w""y o t any t ime? nnn't know No Don't kno"' g. Flo~h or t( :IcC'' h. DisopuNl' e-el r"n;')or~r"> 14. Did the object disappear while you were wat chin g it? If so, how? 15. Did L e c-:.,!:' move behind something at any time , particularly a c loud? Don't Know. IF you answered YES, the n t'!ll wha t 16. Did t he o::,.:;i move in fr ont of s o mething at any t ime, particularly a cloud? (Circle :nc): Yes Don't Know. IF you onsw.::rcd YES, then te ll what 17. Tell in o f~w words the following thin~s about the objest: i B. We .... :sh 1~ -.-ow t he angular size . :.:.ld o match stic k at arm' s length in line with a known objec t and note how IT'uch of th e cbtect is covered by th e l..~od of the match. If you hod pe rformed this experiment at the t ime of the sigh ing r::w -nuch o f the object wou!d n ove been covered by the match head? 19 . Dr::w .:l ;:i:::.o -::,...ill show the s!..:: ;:~ o ' the object or o!Jjects. Lobe l and inc lude in y our sketch any details Tne c:.:e~ r::; J=u sow such cs wh~s, ;>rotrusions, etc., and especially exhaust trails o r vapor trails. Place ..:::-:.r--:-:: .. :::e r~'!: d.Jw:.,J ;~ s\o..., the direction th e object was mov ing. 20~ Do you think you can e s timat e the speed o f tl.1c object ? (C,rcl(" One) Yes 21. Do y":-J ~:. '. \'.::; n estimate how for away fro m you th~ object was? IF yov :::-s,..,.ed Y ES, then h ow fer cwoy would y oll say i t wos? 22. Wher u ,.,.!'r OU located when you sow the object? (C irc/e Orw o. Ins id~ : vilding ;>lone (type) 23. Were you (Circle One ) In tho !Jusiness sectio n of o city? In the residential :>!!ction o f o city? In open countryside? Ncar on airfie ld? F lying over a city? F lying over open count ry ? t...E o r other vchicl~ ot the t ime, then com;>!~te the folloHing q1.1estions: , :.!. i Whet :"ection were you movir;? (Ciclc One) C , =:: JSf g . West b . s~r ~ost d . Sc .. oo;t f. Southwe<>t h . Northwest 2~.2 Y~'"' ::~t were you moving ? ...._ ,~, t-miles per hour. 2-L3 :),~ y: .. stop o t any time whi e )':u were looking o t the object? e. B inocu lars t';o f. T o lescop~ Theodolite 26. In orJ e r rr: ... =:l"' giv e O!> clear o picture as po:.sible of whet you sow, dc:;cribe in your own word s o common object or obr .. ::s ... .,ich, when placed up in the sky, would give the !.Orne oppeoroncc os the object which you sow. 27: In the foiJo...,ing sketc h, imagine tha t you oro a t t he point shown. Place 0:1 "/\"o n the curved line t o s how h ow high the ob;~o:t was a bove tho h orizon (sky lin") whe n y.:~u first sow it. Place o " 8 " on the s ome curvtd li n e t o show h ow h ' h~ obje c t was a bove the horizon (skyline) when y ou lost sow it. Plac e on "A" o n th e compou hen you 'r.; nw it. P lace a " B " o n the compass wh~re yo u last sow the ob(ect. :: ;:l l.:'-e that wil l show t he rr.ol en t\:~t the obJeCt or objects mode. Picco on " A " at the bca inning of th ;:>::-, o "B' -the end o f the path, c~:! s!.u .. .:.ny changes in d irvc:l on during the c our:;e. 2 9 . IF there .. a~ ..... ::;~E T HAN ONE ot-==~-then how many were ther.:t? Oro..., o ;: i :." ::.: ":w they were c":-:;e.J, and put on arrow to show tho direct ion thct th.:y were trav~ling. 30. Hove you ever seen this, oro similar object before. If so grve d ote o r d o te'S and location. w i th you a t the tirr.e you sow the obtect? (Circle 011c) 31.1 IF 7 =:'lswered YES, did they see the objec t too? (Circle One) 1 31.2 Pl~.::.: list the ir names and addresses: ?::!.:Se giv: the following informat io:'l a!:>out yourself: Lost Norc Firs I Nom Midd lc Numc Zone Store tndica3 c~ :::Hitionol informotio, : ::ovt yourself, including any special experience, which might !x: pNiim~r.t. 33. When and t : A-~-: :l id you report that you hod seen t!w obtcct? D ,/ Month Year 34. Octet you corrpletod this questionnaire: 35. Information .., .. :~h you fool pertinent and which is not adequately covered in tho sp~:cif1c points of t he q ust ionn::~ o: o r o narrative explanation of your sighting . Loe .L.ic rte::!.rt.ed at \ODTTTP AL c: U. S. AIR FORCE TECHNICAL IH FORMATION 1"1 ~ questionnaire has been prepared so that you con give t he U.S. Ai~ Force os much inforr.J::.n a s pos s ible concerning t he unidentified aerial phenomenon that you hove observed. Pleo~-. y to answe r as many qu~stions a s y o u poss ib ly con. The information that you give w all be usc:: for research purposes. Your nome will not be used in connection w it h any statements , 1.: 'ons, or publications without your per m ission. We request this personal ir'lformot ion s o hor ri r I s d.,emed necessary, we may contact yo u fo r further details. 1. "Nhcn did~ co~ see t h e object ? Hour Minute:~o ~-li~e Zone. f[ircle One): o . t:ostem b . Lontrof d. Pocrfic (Ctrclc One): a. Daylight SovinJ b. Sto. tdortf = = 4. 'nr . ,. wer~ y~u when you sow the obje ct? P ILGR :CJi S':' ATE HOSP IT.lL Ne:ur ;:>ostol Addro:o:. City or Town Sto tct or County 5. ho"" l:-n3 .... : object in sight ? (Toc ;)urcton) T'.'fo-faprrro:x~)-\--- Mi nuro ~ ! ocond!: c . Not v e ry sure b. ~ c : ly certain d. Just c guess 6. Who ! w:u rhe :~-- en of the s ky? o . Bright b . C loudy 7. IF y ou s ow the o~ :ct during DAYLIGHT, where was the SUN located os you lookl!d ot the object ? (Circle One): o. In front of you b. In bock of y ou c. To your right d. T o y ourlcfr e . Ovcrheod f. Don't rcml'mber FTD oc:T l2 164 Thla f or m oup.-re,.dr FTO 164, J u l !>I, .... tolclo '"ot"olr''" S U OJ t C T TD::' TI'O DEPARTMENT OF THE AIR FORCE HEAOQUARTI:fta ,.O,U:IGN TI!!CHNOLOGY OIVI!JIO N IA"8C I WAIGHTP'ATTK:180N AIR f"OftCt: DA8:1 OHIO o4!J. 3 3 R:~rence y:.ur unidentified observation. '!he informati on llhich \J~ ave received is n:>t sufficient for a scientific evaluation ~r--.!est you complete ~he attached F'ID Form 164 and return i t in t t e nve l ope provij~d. Tnank you for reporting your observation tc ~he i\ir Force. ~P S C. MANATI', Colonel, USAF ctor of Technology er.d Subsystems F?D Form 164 v/envelcpe d . I F you sow the object ol N lt,IIT , what d,d you not c e cnnc-crnnJ the ~fAI<S und MOON? 8. 1 ~TARS (C:c/e One): d. D~ ,., rem~mbctr o . 13right IIIOC.nlight b . Dull moonltght c . N o moonlight -pitch do.rk d . Don't ro~r~emborDON'T RECALL 9. \'rhot we-e I"~ weathe r c onclttions at lnc time you sow tho object ? CLOUDS I~ ~::lc One): Scotte _-: douds d . Thtck c "'cavy clouds 'lYE,\ Hl E R ( C ~rei" One): b. rog, mt!>l, ur ltg c. ,.1\oJNotc: or h_o,y rain c. Don't r~ rrc:mL.:r d . As a light intel1gentl y s bs.pad {y ellO'.vlsh-'!fhit e ) 11. I! u C;)i)e :::.! os o l ight, was i t bngf,ter than th e briglttdst :;tors? (Circle One): o. 3rtght e r b. .J -rrer c . About the some d. Don' t know C.;>..-~:~ brigl,tne5s t o some -.o-.... or object : Ii'f COLOR AND BRIGHTlTESS s~.:c:.AR_TO A YELL OON o . A po-c.: c ;:nd still atony tim~? b . Svd.:!:r.' !. !:d up and rush awvy of any t imt? Dcn' t kno w Don't kno w Brcc~ v; ;) p'lrt:; o r explode? DOI'I' t know e . Chong& br; ~..,t,ess? Don't know f. Chan:JA sn:.""? Do n't know g . F loshorfl.c .!r? Don' t ltnow h. Dtsoppeo r end reappear? Yes f4. D id the objecl d isopt:te or whilo you were w a tching it? If so, how? 15. D:l move behind s ometnin g a t a ny time, p art icularly a cloud? Yes Don't Kno w. IF you onr.wored YES, then tell wha t