1~. CONCLUSION 5-..d:.clli te uRI E F SUMMARY ANO I .. NAL Y ;)IS t . 1 'fPC: OF C lSERVA TION ' 1. COURSE PHYSICAL EVIDeNCE r ound Qt ~ sit:rr;:,. Ob5~rvc r characteria~i CE; 'C.\JO f.Ot:t' ~ of GJ.lnJ..i n.:. .. s cLt.l:t~t~l_i, .J:) U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you can give the U.S. Air Force as much information as passable 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 name will not be used in c:onnectton with any statenents, conclusions, or publications without your permission. We request this personal ir,forn10tion so that if it Ia deensed necessary, we may contact you for further details. 1. When d id you see the object? 3. Time Zone: (C irc:le One): a. t:astern b. Central c. Mountain d. Pacific: 4. Where were you when you saw the obiect? Nearest Postal 2. Tir~ of doy: Hour Minutes (Circle One): ( Circle One): (a) Daylight Saviny b. Standard City or Town State or County 5. now long was object in sight? (Total Duration) a. Certain ~' Fairly certain c:. Not very sure d. Just a guess Minutes Seconds 5.1 How was time in sight determined? ------------------ 5.2 Was object in sight continuously? 6. What was the condition of the sky? 7. IF you saw the object during DAYLIGHT, where was the SUN located as you loolced at the obiect? (Circle One): a. In front of you In baclc of you c. To your ri~t d. To your left (ij Overhead f. Don t renee m ber OCT 62 164 Thle form e\&pereed .. Fm 164, Jul 61, whleh i e obeolete. 1t.L~3L.OPi <Z.> HIGH SCHOCL, t~l A. PARA F~ USAF TF~C LLI~ .i T F J A I A J C RUiDH~AIC~AF A~H D~A .. TM.NT 011' THI AIR P'ORCI MIADOUARTI ... ,ORitON TICHNO&.OO\' DtYII,ON fAPeCt WRIGHTI'A AIR 'ORCI .MI. OMIO aa UFO Observation Reterenee Y'~r un14entit1e4 obaervat1on. The info t1on Which we have reeeived 11 not auttic1ent tor a ac1ent1f1c evaluation. Request you complete the attachecl rrD 164 and return 1 t in the envelope provided. you tor reporting your obaervation to the Air Force. of Teehnology a ~bayateru FTD Form 164 v/envelope 30. Have you ever n thia, or o simi lor obiect before. If ao give dote or date a ond location. elae with you at the time you aow the obiect? (Cirde One) 31.1 IF you answered YES, did they see the obiect too? (Circle One) 31.2 Pleoae llat their nomes ond addressee: 32. Please give the following information about yourself: Lost Nome Firat Name Mldd Name 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 obiect? In the following slcetch, imagine that you a.-e at the point shown. Place or "A" on the curved I ine to show how high the object wa1 above the horizon (s~yline) when you lirst saw it, Place a ''B" on the tame curved line to 1how how high the obiect was above the horizon (s~yline) when you lost saw it. Place an ''A" on the compass when you first saw it. Place a "B" on the compa11 where you lasf saw th~ obiect 28. l.lraw a picture that wi II show the motion that the obiect or objects made. Place an "A., at the beginning of the . path, a "~" at the end of the path, and show any changes in direction during th~ course. 29. IF there was MORE THAN ONE obiect, 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. 20. Qo you thinll you can eatimate the ap .. d of tf,e object? (Circle One) IF you anawered YES, then what apeed would you eatimate? ------ 21. Do you thioll you can e1tlmate how far away from you the obiect waa? (Circle One) {Yea'--, No IF you anawered YES, then how far away would you aay it waa? ~< VC-'tLJ, .._'; ( . Jl' .. ~{s-J 22. Where were you located when you aaw the abiect? (C ire le One): a. lnaicle a building b. In a car ~) Outdoor d. In an airplane (type) 23. Were you (Circle One) a. In the buainess section of a city? (1~) In the residential section of a city? c. In open countryside? d. Near an airfield? e. Flying over a city? f. Flying over open country? 2~. 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 e. South b. Northeaat d. Southeast f. Southwest h. Natthwest 2~.2 How fast were you moving? ,mile& per hour. 2~.3 Did you 1top at any time while you were looking at the object? (Circle One} Did you ob1erve the obiect through any of the following? Eyeglaases Binoculars Yes b. Sun glosse1 Yes Telescope Yes Windshield Theodolite Window glass In order that you can give as clear a picture as poasible of what you sow, describe in your own words a common object or obiectl which, when placed up in the sky, would give the same appearance as the obiect which you saw 14 . Did the ob,eet clisaDoear while you were watehing it? If 10, how? 15. Dlcl the obiect mew t-hind som8thing at any ti~tM'I, porti~ultuly a eloud? (Cirele One): Yes Don't Know. IF you an1wered YES, then tell what 16. Did the ohittct mnve in frnnt of somethinq at ony ti"'tt, p~rticularly a cloud? (Circle One): Yes (@ Don't Know. IF you answered YES, then te II what Tell in a ft~tw words the following things about the obiect: We wish to know the an~ular siztt. Hold a match stick at arm's lenQth in line with a known obiect and note how of the obiect is covered bv the httad of the match. If you had oerformed this experiment at the time of the sightin9, how much of the ob;ect would have been covered by the match head? Draw a picture that wi II show the shape of the obiect or obiects. Label and include in your sketch any detai Is of the obiect that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trai Is. Place an arrow beside the drawing to show the direction the obiect was moving. d. IF you saw the object at NIGHT, what dici you notice concerning the ~ TAkS und MOat-..? 8.1 STAR~ (Circle One); c. Don't remember 8.2 MOON ((,cle One): Bright moon I ight Dull moon I ight c. No moonlight -pitch dark d. Don't remember 9. What were the weather conditions at the time you saw the object? CLOUDS (Circle One): WEATHER (Circle One): b. Hazy b. Fog, mist, or light rain Scattered clouds c. ,\~oderate or heavy rain d. Thick or heavy clouds d. Snow e Don't remember The obi ect appeared: (Circle One): As a light b. T ron s parent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): a. Brighter b. OimnDer lSJ About the same d. Don't know ll.l Compare brightness to some common object: 12. The edges of the obiect were: (Circle One): a. Fuzzy or blurred @ Like a brii:lht star c. Sharply out I ined d. Don't remember 13. Did the obiect: (Circle One for each question) Appear to stand still at any time? Don't know b. Suddenly speed up and rush away at any time? Don't know c. Break up into ports or explode? . Don't know d. Give off smoke? Don't know e. Change br i tj1 tnes s? Don't know f. Change shape? Don't know Flash or flicker? Don't know g. h. Disappear and reappear? Don't know