P .:CJEC..-~l i'3 RECO~O 4. NUMBER OF OBJECTS tO. CONCLUSION INSUFFICIENT DA.r'A FOR EVAllJATION Only Yery limited into~atioD ia given in tb~ re~.t. Th~ obaervera address is not siYen, only hia phone number. Tni~ Or.e Dumber waa called aeYeral timea b\lt '10 one andwerec;. ':n~ Dut. ~. \ .INGTH Of OIII"YATION 11. 1"11, IUMMA"Y AND ANALYIII aounde4 nenous and waa eva a i , .. 9. PHYSICAL EVIDENCE Obaener reported to ~t)' otticer that he bad aeea a c~aa.. tlrinc aauoer. FTD SE P 6 3 0329 (TOE) Pr .. aou edlUon of thte fov. ea> ,. J'- 17. IN,O .... ATION WMICM YOU , L II ... RTINaNT 8UT WHICH II NOT ADaQUATaLY COVaRaD IN TMII QUaiTIOMNAIRa ALTaRNATIYaLY .. ROVIDa A NARRATIYa aJC .. LANATIOM 0, TMa IIOMTINO. ' SI/~Jet.-r R.f'PI,TI!/1 ~G k'f~ P~l)lf~D IN Will)$ WI TPI 'f ~IAt f ~ lr,c t,/)11''~. SllaJ#tT /,t'l'r C,lt W,/11 l,llfe St'JtY.t/2 PINt,S , t,IIKeb f llfiPtt un. "T 1/ITI .,_,~S -rfJ II ~l'f II P ~ U vII /J UUIL I ~ HAlt ll..~#AI-t,IN. t!I-IA ,_T TI~V t,I,NwrS. PAGE I Otr I PAGES U.S. AIR FORC! TECHNICAl INFORMATION This questionnaire has bHn prepared sa that you can give the U.S. Air Force as much Information as possible concerning the unidentified aerial phenomenon that you hove obMrved. Please try to answer as many questions as you possibly con. 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 necetsary, we may contact you for further details. 1. When did you see the obiect? 2. Time of day: Day Month Year 3. Time Zone: (Circle One): a. Eastern b . Central c. Mountain d . Pacific aft e. Other t:~r/1 4. Where were you when you saw the object? (Circle One): (Circle One): a . Nearest P stal Address c T 1ty or own 5. How long was object in sight? (Total Duration) 5.2 Was object in sight continuously? 6. What was the condition of 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 d . To your left b . In bock of you c. To your right " e. Overhead f . Don't remember flO OCT 62 164 This form supersedes FTO 164, JUl 61, w h ich is obsolete. State or County 8. IF you saw the obfect at NIGHT, what dlcl you notice concerning the STARS and MOON? 8.1 STARS (Circle One), 8.2 MOON (Circle One), . c. No moonlight-pitch dark d. Don't remember 9. What were the weather conditions at the time you saw the obiect? c. Scattered clouds d. Thick or heavy clouds 10. The obiect appeared& (Circle One): ~tr,ai:';iclrent WE~R (Circle One)t b. Fog, mist, or light rain c. Moderate or heavy rain Don't remember d. As a light e. Don't remember If It appeared as a light, was it brighter than the brightest stars? (Circle One): a. righter c. About the same d. Don't know 11.1 Compare brightness to 10me common ob ecta 12. The edges of the object were: arply outlined d. Don't remember 13. Old the object& a . Appear to stand still at any time? b. Suddenly speed up and rush away at any time? c. Break up into parts,or' xplade? , , d. Give off smoke? e. Change brightness? f. Change shape? g. Flash or flicker? h. Di~appear and reappear? Don't know Don't.know Don't know Don't know Don't know Don't know Don't know Don't know 8. IF you saw the object at NIGHT, what did you notice concerning the STARS' and MOON? 8.1 STARS (Circle One), 8.2 MOON (Circle One), . lrlght moonlight c,.,Manf"::\ t remember c. No moonlight-pitch dark d. Don't remember 9. What were the weather conditions at the time you saw the object? c. Scattered clouds Fog, mist, or light rain Moderate or heavy rain d. Thick or heavy clouds e. Don't remember 10. The object appeared: (Circle One): ySoiid /:J d. As a light \C.luatnporent e. Don't remember 11. If it appeared as a light, was. it brighter than the brightest stars? (Circle One)r c. About the same d . Don't know 11.1 Compare brightness to s.ome common ob)ecta /Qo lvtrt-+ j)h 12. The edges of the object were: (Circle One): a . Fuzzy or blurred c. arply out I ined d . Don' t remember 13. Did the object: Appear to stand still atony t ime? b. Suddenly speed up and rush awoy at any time? c. Break up into parts or explode? d . Give off smoke? e . Change brightness? f. Change shape? g . Flash or f licker? h. Disappear and reappear? Don't know Don't, know Don't know Don't know Don't know Don't know Don't know Don't know . Official u.s. Air Force Did the object disappear while you were watching It? If so, how? 15. Did the object mave behind 10methlng at any time, particularly a cloud? (Circle One), Yn . "' 8 Don't knaw. IF you answered YES, then tell what Did the obfect move In front of something ot any time, particularly a cloud? (Cirde One): Yes e) Don't know. IF you answered YES, then tell what infrontof: Tell in a few words the following things about th object: 18. We wish to know the angular size. Hold a match stick at arm's length In line with a known object ond note how much of the is covered by the head of the match. If you hod performed this experiment at the time of the sighting, how m~ch of the obfect would hove been covered by the match heo Draw o picture that will show the shope of the object or objects. Lobel and Include in your sketch any details of the object that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place an arrow beside the drawing to ~ow tho direction tho object wa moving. _ ho -ice-[th. ' FO form continued 20. Do you think you con estimate the speed of the ob'ect? (Circle One) IF you answered YES, then what speed woul you eatlmote? "!'" 21. Do you think you can eatimate how far away from you the object was? (Circle One) es No t / IF you answered YES, then how far away would you say It w ,.; -+---- , _ 23. Were you (Circle One) 22. Where were you located when you saw the object? (Circle One): a. In the business section of a city? b . In the residential section of a city? In open countryside Inside a building d. In on a irplane (type) e. Flying over a 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 f. Southwest 24.3 Did you stop atony time while you were looking ot the object? (Circle One) 25. Did you observe the object through ony of th following? o. Eyeglasses Yes e. Binoculars Yes Sun glasses Yes f . Telescope Windshiel d Window gloss g . Theodolite Yes 26. In order that you can give as clear o picture os possible of what you sow, describe in your own words a common object or ob- which, when placed up In the sky, would give the some oppeoronce os the object which you sow. 27. In the following 1lcetch, Imagine that you ore at the point shown. Place on "A" on the curved line to show how high the oblect I wa1 above the horl1on (skyline) when you first 1aw It, Place a "8" on the some curved line to show how high the obltct wa1 above the hori1on (skyline) when you lost saw it. Place on "A" on the compass when you first 1aw it. Place a "8" on the com poll you lost saw the obtect. . 21. Draw a picture that will show the motion that the oblect 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 direction during the course . 29. IF there was MORE THAN ONE object, then how many were there? _ Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling. UFO form continued 30. Hove you ever seen this, oro similar object before. If so give date or dotes ond location. 31. Wos anyone elae with you ot the time you sow the object? (Circle One) Yes 31.1 IF you answered YES, did they see the object too? (Circle One) , 1 31.2 Please list their names ond addresses: 32. Please give the Zone Stole rndicate ony additional information about yourself, Including ony special experience, which might be pertinent 33. When ond to whom did you re ort that you hod seen the object? Month Year Day 3,., Dote you completed this questionnaire 35. Information which you fHI pertlnent and which Ia not adequately covered In the ap-clflc points of the questionnaire or a norrotlve explanation of your s .. htfnt. no YU;) ise n 0 eQ r h o te:abl:v U.S. AIR FORCE TICHNICAL INfOitMA TION This questionnaire haa been prepared so that you can give the U.S. Air Force as much Information aa possible concerning the unldentiRed aerial phenomenon that you have observed. try to anawer as many questions as you possibly can. The Information that you give will be used for research purpoMa. Your name will not be uMd In (onnectlon with any atatements, conclusions, or publications without your permlaslon. We request this peraonal Information 10 thot If It h deemed neceasory, we may contact you for further details 1. When did you see the oblect? 2. Time of day1 (Circle One): Day Month Year 3. Time Zonea (Circle One): a. Eastern b. Central c. Mountain d. Pacific ::_ . J. e. Other CJlf L~t:/) 4. W ere were you when you sow the object? Nearest P stal Address 5. How lonv was object In sight? (Total Duration) 6. What was the condition of the sky? City or Town . \7. 'IF you aaw the object during DAYLIGHT, where was the SUN located as you looked at the object? d. To your left e. Overhead f . Don't remember (Circle One): o . In front of you b. In back of you ., c. To yourrlght Thla form supersede FTD 164, jul 81, which ia obaolete. State or County lA. NOW IMAOIN! YOU A.-E AT THE CI!NTE.-0' THI COMftAII .-osl. PLACI AN A ON THI COMftASI TO INDICATI THI DI .. ECTION TO THI PHENOMENON WHIM ""IT 111M. ftLACF. A e ON THI COMftAII TO INDICATI THI DI.-ICTION TO THI ftH!NOMINON WHIM LAIT StEEN 7. IN THE SKETCH BELOW, PLACE AN A AT THE POSITION OF THE PHENOMENON WHEN "RST SEEN, AND A a AT THE POSITION OF THE PHENOMENON WHEN LAST SEEN. CONNECT THE A AND a WITH A LINE TO APPROXIMATE THE MOVEMENT OF THE PHENOMENON BETWEEN ~A AND a. THAT IS, SCHEMATICALLY SHOW Wt4ETHER THE MOVEMENT APPEARED TO BE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW TO COMPLETE THE LARGER SK,TCH. PAGE 2 OF 9 PAGES UFO form continued U.S. All FOICI TECHNICAL INFORMATION This questionnaire has been prepared 10 that you can give the U.S. Air Force as much Information as possible concerning the unldentlfted aerial phenomenon that you have observed. try to answer as many questions as you po11lbly can. The Information that you g ive will be used for research purposes. Your name will not be used In connection with any statementl, conclusions, or publications without your permission. We request this personal Information 10 that If It is deemed necessary, we may contact you for further details. 1. When did you '" the oblect? Day Month Year 3. Time Zonea (Circle One) a. Easter c. Mountain (Circle One): (Circle One): a.:-1> 9ht Saving ~ Stando~ 4. Where were you when you saw the object? NeoreatPoatal Addreas City or Town 5. How long was object In sight? (Total Duration) Houra Minutea Seconda a. Certai c. Not very sure airly certa1 d . Just a guess 5.2 Was object in sight continuously? 6. What was the condition of the sky? a . Bright 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 tn back of you c. To your right d. To your left e. Overhead f. Don' t remember State or County FTD OCT 62 164 Thia form aup~raedes FTD 164, jul 61, which ia obsolete . I. IP you saw the object at NIGHT, what did you notice concerning the STARS. and MOON? 1.1 STARS (Circle 0M}t 1.2 MOON (Circle One), . ( lrif't moonliQh? ~ . b. Dull moonlight c. No moonlight-pitch dark d. Don't remember d. Don't remember 9. What were the weather condition' at the time you saw the object?. ClOUDS (Circle One)r a. Cleor 1ky b. Hazy 09, mist, or light rain (c,~ Scoiter clouds). c. Moderate or heavy rain Thick or heavy clouds Don't remember e. 10. ,The object appeared: (Circle One): a. Solid Gi! a ligh!) b. Transparent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): ~ <}j. Brightej) . . c. About the some , Dimmer d. Don't know 11.1 Compare brightne11 to same common objech 12. The edges of the object were: (Circle One): a. Fu.u.y or blurred b. like a bright star Sharply outlined