N UMBE R OF G,l tECTS CO~CLUSION LSNGTH OF OBSERVATION o:= On~t::RVATION ~. ?rlOTO~ ?HYSICAL EViDc~;c~ oRIEF SUMMARY AND A:,AL YSIS o o se~vcreo. 20. Do you thin1c you con estimate the speed of the object? (Circle One J IF you answered YES, then what speed would you est~mote? -------- 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? --------- 22. Where were you located when you sow the object? (C ire: le One): a. Inside a building b. In a car c. Outdoors d. In an airplane (type) 23. Were you (Circle One) o. In the business section of a city? b. In the residential section of a city? c. 'In open countryside? d. Near an airfield? e. Flying over o city? 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) b. Northeast d. Southeast f. Soutnwest h. Northwest 24.2 How fast were you moving? miles per hour. 24.3 Did you stop at any time wh i fe you were looking at the obiect? (Circle One) Did you observe the object through any of tne following? a. Eyeglasses Yes No Binoculars Yes No b. Sun glasses Telescope Yes Windshield Theodolite Yes Window glass Yes 26. In order that you can give as clear a picture as possible of what you saw, describe in your own words a common objact or objects which, when placed up in the sky, would give the same appearance os tne object which you saw In the following slcetc:h, imagine that you oret at the point shown, Place on "A'' on the curwted tine to sho-how high the obiect was above the horizon (skyline) when you ltrst ~ow it. Place a "B" on th~ :.ome ct..rv'td lin~ to show how high the object was above the horizon (skyline) when you last sow it. Place an ' 'A" on the compass when you first sow it. Place a "B" on the compass where you last sow tltc obiect 28. lJrow a picture that will show the motion that the object or objects made. Place an ''A" ct the beginning of the path, o "B" at the end of the path, and show any changes in direction dring th~ course 29. IF there was MORE THAN ONE object, then how many were there? ------------ Draw a picture of how they were arranged, an.:J put an arrow to show the direction that they ware traveling. 31.1 IF you an~wred YES, did they se" the objc:t too? ( Circlo On~) 31.2 Please I ist their names and oddre:sses: 32. Pleas~ give the following h,formotion about yourself: Indicate any additional information abou t /ourself, including any special exc~:-i~nc-l, whic h .night be ~ertjnen. 33. When a.,d to whom d id yvu report tha t yoiJ had se_,n the obj ~ct? 34. Dote you completed this questionnaire: 35. Information which you feel pertinent ond which is not adequately covered in the specific points of the questionnaire or a narrative explanation of your sighting TDt:r/T.JFO 0 ,\ATMSNT OF THC: AIR FO'tC~ HCADQUA~TI"S 'O"IIGN TICHNOLOGY DIVISION fA~' lito:) W .. IGHT.JIATT&It.ON AI" 'O"C:' .A.a. OHIO e .. JI UFO Observation .(adianapolls Reference y~:-ur unidentitied observation. The infor:r.ation which ~ have received is not sufficient for a scientific evaluation. Request you complete the attached FTD Foxu& 164 and return 1 t in t~e envelope provided. Thank you for reporting your observation tp the Air Force. S C. MANATr Colonel, USAF irector of Technology and SUbsystems U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you con give the U.S. A ir Force as much information as possible concerning the unidentified aerial phenomenon that you have observed. Please try to answer as many questions as you possibly can. The information that you give will be used fClr research purposes. Your nome wi II not be used in connection with any statement$, ccnclusions, or publications without your permission. We request this personal i,formotion so that if it is deemed necessary, we may contact you for further details. 1. When did you see the object? 3. T ime Zone: (Circle One): 4. Where were you when you saw the object? 2. T i r.,e of day: ~ur Minutes (Circle One): (C;rcle O n e); a. Daylight Saving b. Stondard Nearest Postal Address City or Town State or County 5. how long was obiect in sight? (Total Duration) Hours Minutes Sec:onds a. Certain c. Not very sure b. Fairly certain d. Just a guess 5.1 How was time in sight determined? ------------------- 5.2 Was object in sight continuously? 6. Wha t was the condition of the sky? b. Cloudy 7. IF y ou saw the object during DAYLIGHT, where was the SUN located as you looked at the obiect? (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 t3. IF you ~ow the obJ,' Ct ot NIGHT, what ~1ct you n ~tic-,-conct'r.,ing thP. ~ 1 AI<S und MOON? 8.1 S T AR5 (Circle One): / b.) A few d. Don't remember Brght moonltght o~JII moonlight No moonlight-pitch Jork D on't rememLer 9. Vvho t were the weather conditions ot the time y~ sow the object? CLOUDS (Circle One): o. Clear sky cf 'Scattered clouds d. Thick or heavy clouds NE/.., ThE R f C ,,cfc One): b. Fog, I'T'ist, or l1ght rain c . ,Aod~rot~ or heovy rain e . Don't remember 10. The object appeared: (Circle One): T ronsparent d. As a light e. Don't remember 11. If it appeared as o light, was it brighter than ~ !-te brightest srars? (Circle One): a. Brighter c. Ahout the same b. Dimmer d. D on't know 11.1 Compare brightness to some common object: 12. The edges of the object were: (C irc!e One): o. Fuzzy or blurred b. Like a bri~ht star .c.. Shor~ly out I ined d. Don't remember 13. Did the object: o. Apoeor to stand still at any time? b. Suddenly sp~ed up and rush away ot any time? c. Break up into ports or c.:xplcde? d. Give off smC)ke? e. Change brish tness? f. Chon3e shape? g. Flash o r flic:k~r? h. Disappear ond reappear? (Circle One fo r each question) Don't know Don't know Don't kno'-1 Don't know Don'~ kno411 Dcn't know Don't know 14. D1d the obiec:t diaoooeor while vou wt'trf' watch i"Q it? lf so. how? 15. -Did tnt! nbiftc:t mov~t ~hind !lC\m"'thifiQ at any tim~!, DtJrticul!'rly a clot~d? (Circle One): Don't Know. IF yov answered YES, then tell what No 16. Did th~ obit~tct mov~ in fr(')nt of !lomething nt orw timt~t, oa,.ticulcnly a c lc:"ud? (Circle One}: (y,; Don't Know. IF you onsw-.P"'d YES, then tell what 17. T f'! II in a f~tw wnfd!\ the followinq th inqs about the object: w~ wish to know the an~ular siza. Hold a match stick at arm's lenqth in lin~ with a knt')wn o~iect ond note how much of the obiect is covered bv th.e h~nd of the mntch. If you had perfetmfl!d this "x~rimmt ot th~ tirr~ of the sighting, how much of tha obiect wnuld have, been coverottd by the match head? 19. Draw o picture that will show the shape of the obiect or objects. Lobel end include in yovr sketch any details of tht! object that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trai Is. Place on arrow beside the drawing to show the direction the obiect was moving. 20. Do yov think you con stimate the sp~ecJ of the obiect? (C ire /e On a) IF you answered YES, then what speed would you estimate? ------~ Do you thinlc yov can .. timate how for away from you the object wos'? (Circle One) Y No IF you answered YES, then how far away would you say it was? _ _.:,..cf---=-"j-'-'-~ '-"-'''-'-- 22. Where were y04J located when you saw the ob!ect? (C ire le One): , 23. Were you (Circle One) a. In the business section of a city? ~: ... )n the residential section of a city? c. In open countryside? ro; Inside a bui I ding ' ( In a car d. Near an airfield? e. F I yin g ov ~ r a city ? (c. OutdOCf's d. In an airplane (tvpe) e. At s e a f. Flying over open country? l 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the t ime, than com~lete the following questions: 24.1 What direction were you moving? (Circle One) a. No~ c. East e. Sout~ g. West b. Northeast d. Southeast f. Southwe~t h. N~hwest 24.2 How fast were you moving? _, iles per hour. 24.3 Did you stop at any time while you were looking ot the object? (Circle One) 25. Did you observe tha object through any of the following? Eyeglasse$ Binoculars Yes No Sun glasses f. Telescope Yes No Windshield g. Theodolite Yes No Window gloss 26. fn order that you can give as clear a pkture as possible of what you saw, describe in your own words a commo n object or objects which, when placed up in the sky, would give the sam~ oppearaf1ce as the object which you saw . In th\1 following 1ketch, imagine t~a: ycu oro a t th" poi11t .;h.: vn. F'L:tc~ 'J'' "t.." -:..1 .~1 ~' high th~ object was above the h orizon (skyline) when y o u first S'lw it. f.Jioce o ''B" on th~ lame cvrve d l intt to show how high the obj~tct was above the h orizon (skyline) whe n you las t sow 1t. Ploc-, on "A" on the compos when you lirst ~aw it. Place a .. B" on the compass wh..!re you las f sow the ob1e c t 28. lJraw a picture that wi II show the motion that the object or objects mode. Place on .. A at the beginning of the .. path, a "B .. at the "nd of the path, and s h ow any changes in d irection during th~ course. 29. If there was MORE THAN ONE obiec:t, then how many were there? -----------