Grct:...1d-V i.:?u~l ') . COURse liks a nouse ror.vaou. OCUUone ot Ulle , ...... , .,. oJ .a. ~. Date you co ... l~ted thia queationnaire: 35. lnforn.ation which you fMI pertinent and which is not adequately covered in the specific polnta of the queatlonnoire or a ive explanation of your aighting. DEftARTMENT o,-THE AIR ,-OACE HKAOQUAIItTEIItS 'OIItEIQN TECHNOLOGY DIVISION f A'SC) W"IOHT.~ATTKIItSON AI" f'O"CK ASK. OHIO 484 . eu..,,cT, 1 UFO Observation }{cference your unidentified observation. The information which ve have received is not sufficient for a scientific investigation. Request you complete the attached Fl'D Fonn 164 and ret~trn it in the envelope provided. Thank you for reportinB your obse1vation to the Air Force. . c. MANATT, Colonel, tSAF irector of Technology and Subsyatems FrD Fonn 164 w/envelope U.S. AIR FORCE 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. Please try to answer as many questions as you possibly can. The information that you give will be used for research purposes. Your name wi II not be used in connection with any atateneents, conclusions, or publications without your permission. We request this personal i"forneation so that if it is deemed necessary, we neay contact you for further details.. ~ When did you see the obiect? Time Zone: (Circle One): a. t:astern c. Mountain d. Pacific 4. Where were you when you saw the ob iect? 2. Tirne of day: ------- (Circle One): A.M. or P.M. (Circle One): a -.Fo..ye'\h. \) \H ~ ---_,tioc\-tl CL~r.oJ i.nQ City or Town State or County Nearest Postal Address ; 5. how long was obiect in sight? (Total Duration) a. Certain c. Not very sure b. Fairly certain 0 @Just a guess 5.2 Waa obiect in sight continuously? Yea No . 6. What was the condition ~f the sky? :~ b . Cloudy 7. IF you saw the object 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 right FTD OCT 62 1~ Th&e f evperd rm 164, d. To your left e. Overhead f. Don't rernember 61, which le obeolete. tl. IF you saw the obiect at NIGHT, what did you notice concerning the ~ T AkS and MO~? 8.1 STARS (Circle One): 8.2 MOON ((ircle Ono}: Don't remember a. Bright moon I ight b. Dull moonlight c. No moonlight -pitch dark 9. What were the weather conditions at the time you saw the obiect? , (Circle One): , EATHER (Circle One): Clear sky , b. Fog, mist, or I i gh t rain Scattered c I oud 1 Moderate or heavy rain c. d. Thick or heavy clouds (!.' DM't remember ) . 10. The obiect appeared: (Circle One}: l.M . .,_ (f As a lightJ e. Don't remember b. T ron sparent 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): a. Bri.,ter c. About the same d. Don't know 12. The edges of the obiect were: (Circle OneJ:<:a.: Fuzzy ; blurr!{) b. Like a briwht star c. Sharply outlined d. Don't remember 13. Did the obiect: (Circle One for each question) Don't lcnow Appear to stand still at any time? b. Suddenly speed up and rush away at any time? Don't know c. Break up into parts or explode? Don't know Give off smoke' Don't know e. Change bri~tneas? Don't lcnow Change shape? Don't know g. Flash or fl iclcer? Don't lcnow h. Disappear and reappear? Don't know : 3). Do you thinlc you can eatintate the lpHd of the obiect? (Circle One) IF you anawered YES, then what 1peed would you eatintate? ------ 21. Do you th I Ric you can ea (Circle One) how far away from you the obiect waa? IF you anawered YES, then how far away would you aay it waa? ---4!A-J.._........lllo.~.......,.~L.L. ' l 22. Where were you (Circle One): ~ a. lnaide a bui~ding . @In a car ' . c. Outdocwa d. In 'an airplane (type) 23. Were you (Circle One) . : a. In the buainess section of a city? b. In the residential section of a city? ()1n open countryside? ' . d. Near an airfield? e. Flying over a city? f. Flying over open country? r 2~. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 2~.1 What direction were you moving? (Circle. One) . . e. South : g. Welt . c. Eaat d.-Southeaat (!;)Southwest. : 1 2~.2 How faat wttre you ntOYing? ~(":) mi lea per hour. 2~.3 Did you atop at any time while you were looking at the obiect? (Circle One) 25; Did you obaerve the object through any of the following? Eyegla11e1 ., ' b. Sun gla11e1 c. Windahield e. Binocular f. Teleacope TheocJol ite d. Window gla11 26. In orcler that you can give aa clear a picture 01 poasible of what you aaw, deacribe in your own words a common obiect 01 obiects which, when placed up in the aky, would give the 1 appearance a1 the obiect which you sow 14. Did the obiect disappear while you were watching it? If so, how? Did the obiect move ~.hind sottoething at any time, particularly a cloud? (Circle One): it moved behind: No Don't Know. IF you answered YES, then tell what , Did the obiect move in front of sonoething at any time, particularly o cloud? (Circle One): Don't Know. IF you answered YES, then tell what Tell in a few words the following things about the obiect: ' 18. We wish to lcnow the angular size. Hold a match sticlc at arnt's length in line with a lcnown obiect and note how much of the obiect is covered by the head of the motch. If you had perforneed this experiment at the time of the sighting, how much of the obiect would have been covered by the match head? . 19. Draw a picture that will show the shape of the obiect or obiects. Label and include in your slcetch any details of the obiect that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place an arrow beside the drawing to sh9w the direction the obiect was moving 30. Have you ever seen thia, or a aimi lar obiect before. If ao give date or datea anct location. elae with you at the tinea you aaw the obiect? (Circle One) 31.1 IF you answered YES, did they aee the obiect too? (Circle One) ~ ~ 31.2 PleaM llat their 1 and addr: 32. Pleaae give the fallowing information about youraelf: Firat HolM M14tlle HelM ~! ADDRESS ----. t\. C.~rcl..L~ City Zone State io TELEPHONE NUMBER lftdicate any additional inforneation about yourself, including any special experience, which might be pertinent. 33. When and to wh did you report that y~ had aHn the obiect? In the following a Ieetch, imagine that you are at the point shown. Place an "A" on the curvetl I ine to show how high the object was abOYe the horizon (slcyline) when you lirst saw it. Place a "8" on the same curved line to show how high the obiect was above the horizon (slcyline) when you lost saw it. Place an "A" on the compass when you first saw it. Place a "B" on the compass where you lost saw tho ob;ect 28. L)raw a picture that will show the motion that the object or objects made. Place an "A" at the beginning of the ~ path, a "B" 0t the end of the path, and show any changes in direction during thw 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