l. !\()IIRCE 4. NlJMBE R OF OBJECTS 1 each time s. LENGTH OF OBSERVATION Not reported 6. TYPE OF OBSERVATION Ground Viaual Not re )Orted 8. Pt10TOS 9. PHYSICAL EVIDENCE P,:QJECT 1CJ73 RECORD 2. LOCATION Waldwick~ New Jersey 10. CONCLUSION INSUl''FICIENT DATA FOR EVALUATION Foxm l64 sent to observer for addition~l reb -:\! yet~ ... ,hen re ed cae-v' 11. BRIEF SUMMARY AND ANALYSIS szz CASZ F l LE information nnd not P"loua adlllona or lhla rona D'IA1 ~ uaal!. U.S. Alit FOftCE TECHNICAL INFORMATION This questionnaire has been prepared 10 that you can give the U.S. Air Force as much Information as possible concerning the unidentified aerial phenomenon that you have observed. try to answer as many questions as you pollibly can. The Information that you give will be used for research purposes. Your name 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 deemed necessary, we may contact you for further details. When did you see the object? Hours Minutea (Circle One): 3. Time Zone1 (Circle One): a . Eastern b . Central c. Mountain (Circle One): a . Daylight Saving b. Standard Neoreat Poatol Addreu City or Town State or County .5. Ht.\1\ lun1 war, object In sight? (Total Duration) Houra Mlnutea S.conda a . Certain ..-c. Not very sure b . fairly certain d . Just a guess 5.2 Was object in t ight continuously? 6. What was the condition of the sky? a . Bright \ a . Bright b . Cloudy IF you saw the object during DAYLIGHT, where was the SUN locate d as you looked at the object? (Circle One): a . In front of you d . Toyour left b. In bock of you e. Overhead To your r ight f. Don't re member FTD OCT 62 164 This for m auawr~des FTD 16 ... Jul 81, wh1ch 11 ob50lete. 8. IF you saw the obfect at NIGHT, what did you notice concerning the STARS.and MOON? 8.1 STARS (Circle One)r 8.2 MOON (Circle One): a. Bright moonlight b. Dull moonlight 1... c. Many c. No moonlight-pitch dark d . Don' t remember d. Don't remember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): a. Clear sky c. Scattered clouds d. Thick or heavy clouds The object appeared: (Circle One): WEATHER (Circle One): b. Foe, mist, or light rain c. Moderate or heavy rain e. Don't remember a . Solid d . As a light b. Transparent e. Don' t remember If it appeared as a light, was it brighter than the brightest stars? (Circle One): a . Brighter c. About the same b. Dimmer d . Don't know 11.1 Compare bri9htness to some common obfect: 12. The edges of the object were: (Circle One): a . Fuzzy or blurred b. like a bright star Sharply outlined d . Don' t remember Did the object: (Circle One for each question) a . Appear to stand still at any time? Don't know Sudd&nly speed up and rush away at any time? Don' t know c. Break up into parts or Yes No Don' t know Yes No Don't know Change brightnen? Don' t know f. Change shape? Don' t know g . Flash or flt.ker? Yes No Don' t know Disappear and reappear? Na Don't know OfficiaiU.S. Air Fort Did the object d iMippeor while you were watching It? If so, how? 15. Did the object move behind something at any time, particularly a cloud? (Circle One), Yes'\ ~::> Dan't know. IF you answered YES, then tell what 16. Did the object move in front of something at any time, particularly a cloud? (Circle Otte)r Yes Dan't know. IF you answered YES, then tell what 17. Tell in a few words the following things about the object: 11. We wish to know the ongulor size. Hold a match stick at arm's le ngth In line with a known object ond note how much of object is covered by the heod of the match. If you had performed this experiment at the time of the sighting, how much object would have been covered by the match head? 19. Draw o picture that will show the shape of the object or objects. Lobel and Include in your sketch any details of the ob; that you saw such as wings, protrusions, etc., and especially exhaust trails or vapar trails. Place an arrow beside the drctwl to .how the d irection the object was moving. ;e UFO form continued 20. Do you think you can estimate the speed of the object? (Circle One) IF you answered YES, then what speed would you estimate? _... 21. Do you think you can estimate how far away from you the object was? (Circle One) .Yes \ No 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? a . In the business section of a city? Inside o building b . In the residential section of a city? c. In open countryside? d. Near an airfield? d . In an airplane (type) e. Flying over a city? e. At sea f . Flying over open country? g. Other 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) a. North c. East b. Northeast d. Southeast f . Southwest 24.2 How fast were you moving? miles per hour. 24.3 Did you stop at any time while you were looking at the object? (Circle One) 25. Did you observe the object through any of the following? o. Eyeglasses e. Binoculars b. Sun glasses f . Telescope c. Windshield g . Theodolite h. Northwest d . Window glass In order that you can give as clear o picture as possible of what you saw, describe in your own words a common object or ob iects which, when placed up in the sky, would give the some appearance as the object which you sow. )~rricial 1 1.s: In the following sketch, Imagine that you are at the point shown. Place an "A" on the curved line to show how high the obfect above the horizon (skyline) when you first saw lt. Place a " 8" on the same curved line to show how high the object wos above the horizon (skyline) when you last saw lt. Place an "A" an the compan when you first saw it. Place a " 8" on the com pass when you last saw the object. Draw a picture that will show the motion that the object or objects made. Place an "A" at the beginning of the path, a ''8" at the end of the path, and show any changes in d irection during the course. 29. IF there was MORE THAN ONE object, then how many were there? _ Drow o picture of how they were orronged, ond put an arrow to show the d irection that they were traveling . 30. Have you ever seen this, or a similar object before. If so give date or dates and location. 31o Was anyone else with you at the time you saw the object? (Circle One) 31.1 IF you answered YES, did they see the abject too? (Circle One) 32. Please give the following information about yourself: 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? ,Official U.S. Air Fo 34. Dote you completed this questionnaires Information which you feel pertinent and which Is not adequately covered In the specif ic points of the questionnaire or a narrative planation of your sighting. Jat/9 Oct 67) . ~ UIV .. Obaenat1on, AboUt 25 July 1967 Because ~ sighting occurred ao lons ago and becauae ot the ot ua exact date, w are ''"ble :to 1Dveat1gate XPUl' al&ht.lD& 2. It 1n the 1\lture 70'1 have neareat A1r lbrce Baae another a1pt1q, C. MARA'l'l', Colonel, USAP tor ot ~chnoloQ and a&baya contact the U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you con give the U.S. Air Force as much inforneation 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 wi II be used for research purposes. Your no~ne wi II not be used in connection with any statements, ccnclusions, or publications without your permission. We request this personal inforntation so that if it is deen11d necessary, we ntay contact you for further detai Is. 1. 'Nhen did you see the obiect? Htlur Minutes (Circle One): 3. Time Zone: (Circle One): a. tostern b. ~entfat) (Circle One): a. {Pa~light Savin~' b. Standard c. Mountain d. Pacific 4. Nhere were you when you saw the obiect? Nearest Postal Address City or Town State or County S. 11ow long was obiect in sight? (Totol Duration) a. Certain c. Not very sure b. <qirly 5ertai!!"> d. Just a guess S.2 ~as obiect in si~t cc;,ntinuously? 6. What was the condition of the slcy? a. (] right ) 1. IF you sow the obiect during DAYLIGHT, where was the SUN located as you looked at the object? (Circle One): a. In front of you b. In back of you c. To your ri~t d. To your left e. Overhead f. Don't renoember FTD OCT 62 1~ Thle form eupereed .. Fm 164, Jul 61, which le obaolete. DEPARTMENT OF THE AlA FORCE HEADQUA"TE"S FO"EIGN TECHNOLOGY DIVISION I A,SC l W"IGHT.~ATTE"SON AI" FO"CE AaE. OHIO .5.33 UFO Observation! Aug 67 Reference y~ur un1dent1t1e4 observation. 'nle informAtion which ve have received is not autt1e1ent for a scientific ~valuation. Request y ou complete the attachecl F'TD Fo1 01 164 and return it in the enve lope provided. Thank you for reporting your observation t o the Air Force. . S C. MANA'.rr Colonel, USAF rector of Technology and 3ubayatema ~D Form 164 w/enve l opc d. IF you saw the object at NIGHT, whot did you notice concerning the ~TA~S ond MO~? 8.1 S T AR5 (Circle One}: d. Don't remember 8.2 MOON (C~rcle One): a. Bright moonlight b. Dull moon I ight c. No moonli ht -pitch dar~ d.~ Uon ~ remembe!) 9. V.hat were the weather conditions at the time you sow the object? CLOUDS (Circle One): c. Scattered clouds d. Thic~ or heavy clouds NEA THER (Circle One): b. Fog, mist, or light rain c. .~oderate or heavy rain e. Don't remember 10. The object appeared: (Circle One): :f.(As a I ight ) e. LTent ren:ember b. Transparent 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): o. @fighter) c. About the some b. Dimmer d. Don't ~now 11.1 Compare brightness to some common object: 12. The edges of the object were: (Circle One): a. Fuzzy or blu:-red b. Li~e a briyht star c. Shar~ly out I ined d. Don't remember 13. Did the object: a. Appear to stand still at any time? b. Suddenly speed up and rush away at any time? c. Brealc up into parts or explode? d. Give off smolce? e. Change brid1tness? f. Change shape? g. Flash or flic~er? h. Disappear and reappear? (Circle One for each question) Don't lcnow Don't lcnow