S. L.c.~G'iri uF O&SIRVATION ,7. COURSE ! 9. PriY~:CAL EVIDENCE saw a b:-i.;l:t b!uish gr3an lign't tr.~: ;.:cvad ., elav.a~ :on. n.i azb\.lt'~ a;. .. e rt;.. (TOE) 3~. Date you c this questionnaire: ion which ,., '-1 peotinent ancl which is not adequately covered in the specific points of the ire ....,.;,. planation af ,our 1 ightiftl. llti~\.Y TO SlJR J lC:T DE,.ARTMENT 011' THE AU' II'ONCE HKADQUARTKR. ,.O,_KIGN TKCHNOLOGY DIVI.ION f A,.SC) WRIGHT-~ATTKHON AIR ,.ORCK aAea. OHIO 45433 UFO Observation Reference your un1dentit1ecl obaervat1on. 'Ihe information vhich ve have received 1a not surticient tor a scientific evaluation. Request you complete the attached F'l'D 164 and return it in the envelope provid~d. Thank you tor reporting your observation to the Air Force. JAMES C. MANATT Colonel, USAF Director or Technology and ~bayatema F'TD Form 164 w /envelope 1\J h JlCT D.-ARTMENT 0,. THE AI" P"Of'Ca HKADQUA.-Ta.-s ,o.-aiGN TKCHNOLOGY DIVISION f A'SC) W,_IGHT-~ATTK.-SON AI,_ ,o.-ca .A8K. OHIO .5.33 UFO Observation , 11 Sep 67 Reference your unidentified obHrvation. 'Ibe inform&tion which . ve have received is not sufficient tor a scientific evaluation. Request you complete the attache<l F'l'D Foza1 164 and return it in the envelope provided. Thank you tor reporting your observation to the Air Force. S C. MANA'l'l', Colonel, USAF rector of Technology and ~bayateM FTD Form 164 w/envelope U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force as much inforntation as possible concerning the unidentified aerial phenon;enon that you have observed. Please try to answer a ntany questions as yau poisibly can. The information that yoU give will be used for research purposes. Your nam1 will not be used in connection with any statements, conclusions, pulalications without ytNr ission. We request this personal i"*ormlltion so that if it is-.... Rcs , we ._, contoct y for further details. . 1. When did you s .. the olt;.ct? 3. Time Zone: (Circle One):. a. t:ostern b. Central 4. Where were you when you saw the obiect? 2. Tiroe of day:_ , - (Circle One): or (Circle One): a. Daylight Saving _ ..--- b. Standard Nearest Poatel Atldr City Town S. now long was obtt in sight? (Total Duroti.,.) a. Certain c. Not very sure b. FoiriJ certain d. J\lst a guess S.l How wos tiiile in sight deterwnined? -------~---------- 5.2 Was obiect in si9tt continuously? 6. What was the condition of the slcy? o. Bright- Stote 01 County 7. IF you sow the obiect during DAYLIGHT, where was the SUN located as you looked at the obiect? (Circle One): o. tn front of you 1.. In bac:lc of you c. To Y0416 right d. To your left e. Overheaf f. Don't remember FTD OCT 62 164 Thte f nrn .... I'Tn 164. Jul 61, which la oataolete. tJ. IF you sow the obiect at NIGHT, what did you notice concerning the ~ T AkS und MOON? 8.1 STAR~ (Circle One): Don't remember 8.2 MOON ((ucle One): Bright moon I ight Dull moon I ight No moonlight -pitch dark Don't remember conditiOftS cit the tiMe yOY CLOUDS (Circle One}: WEATHER (Circle On): Clear skr .. o. Qqe b. Fog, mist, or light rain c. Moderate or heavy rain c. Scattered clouds d. Thiele or heavy clouds d. Snow e. Don't ren~amber 10. The obiect opp1ared: (Circle One): a. Solid d. As a I ight~ b. Transparent e. Don't remember If it appeared as a light, was it brighter than the brightest stars? (Circle One): a. Br i ~ter / c. About the same b. Dimmer d. Don't know 11. 1 Compare brightness to some common obiect: 12. The edges of the object were~ (Circle One): a. Fuzzy or blurred b. Like a briyht star c. Sharply outlined d. Don't remember ' v f}VY' I l) 13. Did the obiect: (Circle One for each question) Apoeor to stand still at any time?' Don't know b. Suddenly speed up ancJ rush away at any time? Don't lcnow c. Break up into parts or explode? Don't lcnow d. Give off smoke? Don't know e. Change bri~tneaa? Don't know f. Change shape? Don't know g. Flash or flicker? Don't know DisapJMtor ond reappear? Don't know 1A. Did the ob~ect clisaopaar while you were watching it? ff so, how? 15. Did the obiect tnove W.incj sono"thing at any timJJ, particulttrly a cloud? (Circle One): Don't Knew. IF you answered YES, then tell what 16. Did the obiect in ~ont of som~ing at any time, p<lt'ticularly o cloud? I (Circle One): Don't Know. IF you answerecf YES, then tell what 17. Tell in a fttw words the following things about the obiect: 18. We wish to lcnow the an~ular siz.-. Hold a match stic:lc at arvn's lene~th in line with a lcnown oltfect ancf note how much of the ohiect is covered by the head of the match. If you had perforn:ecl this Jricc:nt ot th ti1t11 of the sighting, how much of the object wauld hae been coYered by the match head? Draw a pictu,.. that will show the shape of the obieet or obiects. Label ancl include in yow slcetch any details of the object that you saw such as wings, protruaiorta, etc., and especially exhaust trails or trails. Place an arrow beside the drawing to show the direction the obiect was mewing. 20. Do you thinlc you con estimate the speecJ of the o~iect? (Circle One} IF you onsw1r1d YES, then what sp1ed 'would you estintate? ------- 21. Do you thinl& you c (C lrcle One J how for aM~y froM you the obiect was? IF you answr~ YES, lisen how fer awe, would you say it was? --------- 23. Were you (Circle One} (Circle One): a. In the tusiness section of a city? b. In the residential section of a city? c. In open countryside? a. Inside a lluilding b. In a car~ c. Outdoara d. Near on airfield? d. In an airp e. Flying over a city? e. At sea f. Flying over open country? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the tin:1, then complete the following questions: 24.1 What direction were you moving? (Circle One) c. East e. South Southeast f. h. Noeth .. st How fast were you 1110~ing? miles per hour. Did you 1top at caay tin:e while you were loolcing at the object? (Circle One) 25. Did yau oltsere the o&.iect through any of the following? Eyegla1se Yes Binoculars Yea No b. Sun Yea Windlhielct Theodolite Yes cl. Window glass 26. In order that you can give as cler:w a pictureas possible of what you saw, describe in your own words a common obiect cw obaects which, when placed up in the sky, would give the s appearance as the obiect which you saw In the followint slcetch, imagine that you ore at the point shown. Place ar "A" on the curvefl line to show how high the obiect s above the horizon (slcyline) when you lirst sow it. Place o .. 8" on the sow:e curved line to show how high th. oltiect was above the horizon (slcyline) when you last saw it. Place on "A" on th. compass when you lirst saw lt. Place a .. B" on the compass where you last sow the object 28. lJraw a picture that wi II show the mot ion that the obiect or ob iects made. PI ace an "A" at the beginning of the path, a "B .. at the...., of th path, and show any changes in direction during th course. 29. IF theta was MORE THAN OhE object, then how many were tl:erw? ----------- Draw a picture of how they wr arranged, anJ put an 01row to show the direction that they weN traveling 30. Have you.,., n this, or a similar obiect before. If 10 give date or dates and location 31. Was anyone elM with you at the time you saw the obiect? (Circle On) 31.1 'IF you anawa;e4 YES, did they the niect too? (Circle One) ~u_At;,t;af.E 32. Please give the following information about yourself: Firat H,.. Middle ....... "]& u)o ~utf,J TELEPHONE NUMBER Indicate ony additional information obout yourself, including any special experience, which might be pertinent 33. When and to whom did you report that you had seen the obiect?