CONCLUSION INSUl''FIC I Ell~ J IA~A FvR EVA IllATION t. Nlfl~l'ER OF OBJECTS LENGTH OF OBSERVATION BRIEF SUMMARY AN:) ANALYSIS 510 minutea lYPE OF OBSERVATION Ground V1a!.181 PHYSICAL EVIDENCE Prevloua edltlona of lhla form CIIIJ l.e uend, INT 0" TH. AI,_ P'OIItC. MIADQUA ,O.IION TICMNO&aOOY DIVIIION fA PIC t WaiOMT.~AnlaiON AIR 'ORCI .All. OMIO 11 UFO Observation a., June 6? , Cal1torn1a Reference Y'~r un14ent1t1e4 obeervation. The information Vhtch we have reeeiYed is not autt1c1ent tor a scientific evaluation. Request you complete the attached l''rD Form 164 and return it 1n the envelope provided, Thank you tor reporting your observation to the Air Force. S c. MANAtt-r, Colonel, USAF 1 Atch ,.Protor of Technology and ~beyateu F~D Form 164 v/envelope U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Foree as much informption as possible concerning the unidentified aerial phenomenon that you have observed Please try to answer as many questions as you possibly con. The information that you give wi II be used for research purposes. Your na111e will not be used in connection with any statements, conclusions, or publications without your permission. We request this personal information so that if it is deen:ed necessary, we may contact you for further detai Is. 1. When did you see the object? 3. Time Zone: Month Year (Circle One): a. tastern b. Central c. Mountain 4. Where were you when ou saw the object? 5. How long was object in sight? (Total Duration) a. Certain @Fairly certain (Circle One): (Circle One):@ Day I ight Saving b. Standard City or Town State or County Hours Minutes Seconds c. Not very sure d. Just a guess 5.1 How was time in sight determined? --------.,----------- 5.2 Was obiect in sight continuously? Yes No 0) S J N 1 ' 6/3{~ 6" 0 6. What was the condition of the sky? 7. IF you saw the obiect during DAYLIGHT, where was the SUN located as you looked at the. :o~ .... ...:~------ (Circle One): a. In front of you b. In back of you c. To your right d. To your left e. Overhead f. Don't remember FTO OCT 62 164 Thle form euperaedea FTD 164, jul 61, which la oba91ete 8. IF you saw the object at NIGHT, what did you notice concerning the 5 TARS and MOON? 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): WEATHER (Circle One): a. Clear slcy b. Fog, mist, or light rain c>2 Scattered clouds c. Moderate or heavy rain d. Thiele or heavy clouds d. Snow e. Don't remember 10. The object appeared: (ci,'Solid (Circle One): d. As a light b. Transparent e. Don't remember If it appeared as a light, was it brighter than the brightest stars? GJ Brighter c. About the same d. Don't know 11.1 Compare brightness to some common object: (Circle One): 12. The edges of the object were: (Circle One): a. Fuzzy or blurred b. Like a briyht star c. Sharply out I ined d. Don't remember 13. Did the object: (Circle One for each question) a~ Appear to stand still at any time? (j;;J No b. Suddenly speed up and rush away at any time? Yes No c. Break up into parts or explode? Yes No d. Give off smoke? Yes No e. Change brightness? Yes No f. Change shape? Yes No g. Flash or flicker? Yes No h. Disappear and r~rpear? L2 Yes .,_-{) No Don't know Don't know Don't know Don't know Don't know Don't know Don't know Don't know 20. Do you think you can estimate the speed of the obiect? (Cirele 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 answered YES, then how far away would you say it was? --------- 23. Were you (Circle One) 22. Where were you located when you saw the object? (C ire le One): I a. r1 the business section of a city? a. Inside a building b. In a car c~Outdoors '-111~, In an airplane (type) C: In open countryside? d. Near an airfield? e. Flying over a cify? 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) c. East e. South Northeast d. Southeast f. Southwest h. Northwest How fast were you moving? .miles per hour. 24.3 Did you stop at any time while you were looking at the object? (C ire /e One) 25. Did you observe the obiect through any of the following? Eyeglasses Binoculars Yes No b. Sun glasses c. Windshield Theodolite Yes No d. Window glass 26. In order that you can give as clear a picture as possible of what you saw, describe in your own words a common object or obiects which, when placed up in the sky, would give the same appearance as the object which you saw. 27. In the following slcetch, imagine that you are at the point shown. Place an "A" on the curved line to show how high the obiect was above the horizon (slcy I ine) when you first saw it. Place a "B" on the same curved I ine to show how high the obiect was above the horizon (skyline) when you lost saw it. Place an "A" on the compass when you first saw it. Place a "B" on the compass where you Ia sf saw the object 28. Orow a picture that will show the motion that the object or objects made. Place an "A" at the beginning of the path, a "B" at the end of the path, and show any changes in direction during the course. 29. IF there was MORE THAN ONE object, then how many were there? ------------ Draw a picture of how they were arranged, anJ put an arrow to show the direction tnat they were traveling. 30. Have you ever aeen thia, or a aimilar obiect before. If 10 give date or dates and location. 31. Was anyone elae with you at the time you saw the obiect? (Circle One) 31.1 IF you anawered YES, did they the obiect too? (Circle One) 31.2 Pleaae list their namea and addreaae 32. Please give the following information about yourself: Lost Nome First Nome Middle Nome vVoolt1"'D Jltt-JS TELEPHONE NUMBE Indicate any additional information about yourself, including any special experience, which might be pertinent. 33. When and to whom did you report that you had seen the object? 3. Date you completed thia questionnaire: 35. lnfarn~ation which you feel pertinent and which i1 not adequately covered in the specific points of the queationnaire or a narrative explanation of your sighting