j V ..J I WI' Or G BJECTS CONCLUSION 0 O?.SE~VA TIO:-.! .Jn3cRVATION BRIEF SUMMARY AND A~ALYSIS U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you con give the U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you have observed. Please try to answer :n many questions as you possibly con. The information that you g ive will be used for rese1.1rch J.'Urposes. Your nome will not be used in connection with any statements, conclusions, or publicotions without your permission. We request this personal ir"formation so that if it is deemed necessary, we may contact you for further detai Is. 1. When did you see the obiect? (Circle One): :/ Month Year 3. Time Zone: (Circle One):~ to stern (Circle O ne): ..o.' Daylight Soviny b. Central b. Standard c. Mountain d. Poe ific 4. Where were you when you sow the object? Nearest Postal Address City or Town Stote o r County 5. how long was object in sight? (Total Duration} Minute5 Seconds a. Certain c. Not very sure b. Fairly certain d. Just a guess 5.2 Was object in sight continuously? 6. What was the condition of the sky? a. Bright 7. IF you sow the object during DAYLIGHT, where was the SUN located as y ou le~oked ot the object? (Circle One): a. In front of you d. To yovr left b. In back of you c. To your right e. Overhead f. Don't remember Thla Corm aup4tr!tedea FTn 16 .. , j u 1 61, whic h ia ob~olete. d. IF you saw the object ot NIGHT, what d ici you notice c o ncerning th., ~ T AkS und MOON? 8.1 STARS (C irde One): d. Don't remember 8.2 MUON (C~rcle One ): a. Bright moon I ight b. Dull moonlight c. No moonlight -pitch doric d. Don't remember 9. V.hot were the weath8r conditions at the t i me you saw the object? CL QUOS (Circle One): HEATHER (Circle One): b. Fog, mist, or I ight rain Scattered clouds Moderate or heavy rain Thick or heavy clouds e Don't remember 10. The object ap~ared: (Circle One): a. Solid ( As a f ight b. T ron sporent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): a. Brighter ~ About the same d. Don't know 11.1 Compare brightness to some common object: 12. The edges of the object were: (Circle One):/'~ Fuzzy or blurred ~ Like a bri~ht star c. Sharply outlined d. Don't remember 13. Did the object: (Circle One for ecx:h question) Appear to stand still at any t ime? Don't know b. Suddenly speed up and rush away at any t ime? Don't know c:. Break up into ports or explode? Don't know d. Give off smoke? Dont know e. C hange brig,tness? Don't know f. Change shape? Don't know Flash or flicker? Don't know g. Disappear ond_reappeai? Don't know 14. Did the obiect di.Jonpeor while you """'~ watching it? If so, how? Did the object move ~hind 1\0,flttninq nt any time, porticul:uly a clc1Jd? (Circle On&): Yes fNo) Don't Know. IF yo1... onswftred YES, thll!n t~ll whot Did the obiect move in front of something at any time, i)orticu la rly o cloud? (Circ:le Oue): Yes (N;} Don't Know. IF you on~wt~tred YES, tnen tell 17. T "'II in a f~w words th~ following things obout thi! object: 18. We wish to know the ongulcr size~ Hold o match stick at orm s l-ength in line with a kn.,wn object und r.ot.,ho""" ~ much of the obiect is covered by th~ head of the match. If you hod performed thi-; e>'periment ot th~ tin e ~r '1:-.e i si~hting, how much of the object would hava been covered by the match head? t of the object thot you saw such as wings, protrusions, etc., and especially exhaust t roi Is or vapor troi Is. P I oce an arrow beside the drowi ng to show the d irecticn the obiect wo:; moving. (Circle One } IF y.>J answered YES, !h,, n what spt d would y o t e1tirnot()? 21. Do you think you c:an ~'timote how f e r owoy frorr. youth~ obj-oct w :H? (Cirele One) IF )'O\J answered YES, then how far oway would you soy it was? --------------~ 22. Whr~ were you loc:at~d when you sow th& object? (Circle One): o. Ins ide a bui I ding b. In a ear d. In a n airplane (typ-e) 23. Were yov (Ctrcle On~) a. I n t:-.e bu~i,.,e.;s section of o ~i~t? (f.. !n the residentia l Sl!ctio n uf o ciry? c. In 0 9'!n c:ot.tn'r'\lside? d. Near 'Jn oirfi.,1d? e. Flying vV\)r o city? f. Flyi!1g ove~ op~n COIJs'lt!'y? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, the n complet3 the foUowing questions: 24.1 What direction w~re you mo't'ing? (Circ:IP. One) a . Nor:-h c . East e. South b. Northeast d. South~ost f. Southwest h. Northw~st 24.2 How fast were yoJ moving? ---J_tTlil~s per hour. 24.3 Did you stop at any time wh i I~ you wer~ looking at tha object? (Circle One) Yes No 25. Did you observe the object through a ny of the following? c. eyeglasses Binoc ulars Sun glasses Yes c:. Windshield Theodolite d. Window g1oss '26. ln ord.,r that you con give as clear o picture os possibl~ of what y ou sow, $cribe in your own words o common obj~ct c r objects which, wh.en ~laced up in t he sky , would giveth!!: scm~ opj:):Hlr01Ce a s th~ obj~ct which yov saw. 27. In the following s~<.,tch, imagine that you ora at the point ~hown. Ploc~ an "A' ' \"m the C'Jrv:,d line to show ht>w high the obiec:t was nbove the horizon (skyline) when you first sow it. Place o "B'' 0 11 1h~ sam' curved lme to show how high the object was nbove the horizon (sky I ine) when you Ia~ t s ow it. Place on "A" on the compos s when you lirst saw it. Place a "B" on the compass where you lost sow tl1c object. 28. Draw a picture that will show the motion that the object or objects mode. Place on A" at the beginning of the path, a .,B" at the end of the path, and show any changes in direction during th~ 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 that they were traveling 31. Was anyone ebe with ~"OJ u t tha tim~ 't . ..~ ~f.JW t: :1 ohj~ :?? ( Circle On~,. 31.1 IF you answred YES, did th.:ty ""~ tL.! vbj.Jct too? ( (ir'c/ ~One) 31.2 Please li3t their names and addrejStH: 32. Pleas~ give the followiag informotkm alJout youf:id~; ~\iJdla Hame TELEPHONE NUMB 33. Wh~n ond to whom Jid ~l:)lJ r cd that y 'Ju hod se:an ;-hu vbj.:c.? Monrh Year 34. Date you com,aleted this questionnaire: 35. Information which you feel pertinent and which is not adquately covered in the specific points of the questionnaire or a narrative planation of your sighting. IUit~"'' TO Ol!~A,.TMI.'fT OF TH~ AtR FORC~ HIADQUA"TIIItS PO"ItON TICHNOLOGY DtYietoN ( C) w.-IOHT.,An'l)tiON AI._ PO,.CI .A.a. OHIO e43a UFO Observation Reference y.)ur unidentified observation. 'nle information \lhich we have received is not aufticient for a scientific evaluation. Request you complete the attachecl FTD Form 164 and return 1 t in the envelope provided, Thank you tor reporting your observation to the Air Force. .:T~s c. MANA'IT Colonel, USAF ?rector of Technology and SUbsystems F~D Form 164 v/envelope