DATE ~ Tl. G~OUP 4. NUMaER OF Oa JECTS LENGTH OF 03SERVATION l 0 r-tinute.s 6. TY?E OF OBSt:~VATION G:-ound-Viaual 7. COlJRSE 9. PHYSICAL EVIO!NCE P~OJECT 10073 RECORD 2. LOCATION 10. CONCLUSION Other (CO~ICTING DATA) 11. BRIEF SUMMARY AND ANALYSIS The observer reported to the duty officer that he hQd sibhted ar.d photographe d a UFO. A For.c 117 was s ent to the obserter but it wa~ returned tor a sighting ot ~ Sept 66. FTD $ E P 6 3 0- 3: ? {iDE) p,..vloue edlt! !)ftt ol lhh lo,. m1 b. uud, AFR 80-l7(Cl) 22. HAVE YOU EVEP. SEEN THIS OR A SIMILAR PHI::NOMENON BEFORE? g'IES 0 NO. IF YES," GIVE DATE AND 21. WAS ANYONE wltiTH YOU AT THE TIME YOU SAW THE PHENOMENON? 0 YES 0 NO. IF vES,"' DID THEY SEE IT TOO? [Jpte:s C:l f'tO. A. 1q ~ ~ES AND ADDRESSES GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF LAS T NAME, FIRST "lAME, MIDDLE NAME C:CUPATION AND ANY EXPERIENCE WHIC H MAY BE PERTINENT. 25. WHEN Jl~O 7 0 If.,-..;: .J 'YOU REPORT THAT YOU IIAO SIGHTED THIS PHENOMENON' ~6. DATE YOU COM U~-=::. THIS QUESTIONNAIRE. PAGE 8 OF 9 PAGES AFR f'0-17(Cl) SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIOMMAIRE lfUOO,.; T fiURF:AU APPROV AI. NWAII,.;R 21-Rl$1 Tilt~ (,HIE~T10~';'\IRE HAS nEEN Pl~EPAHEl1 SO THAT YOll CAN CiiVJo: TilE U. S All~ FOIK'fo: AS MtJCII INFOHMATJON A~ POSSIBLE C'l.1~CER~ING T11E UNIDENTIFll~D Plll:NOMENON TlfAT YOU IIAVE O B S I.HVE.n. PLEASE TRY TO ANSWE~ 1\LL ()F THE QUESTlO -TilE INFOR~I.\TION YOU GIVE WILL BE lJSl-:1> FOR I~ESl~A"Ctl PURPOSES YOU!~ NA~n.: \\!Lly NOT DE USED IN CONNECTION WITH ANY OF YOUR STA'fi.MENTS OR CONCI.US10NS WITHOUT \' Olllo! PER~1:'"ld'\. RETUI{N T O AIR FOHCE. BASE INVF.STIGATOR FOR FOI~WAI~I>lNG T O FTD (TI>ETR), WI?J(~Jl [' . P ATTEHS )S -\,; ), OH I 0 45433, 11\W AfH 80. j 7 . (IF A f)J)f "rtONA I. S HERTS AUf-: N Df~IJ r ou NA kU A'/'/ V,.: OR SK WrCIIT:.<:. A TT..t Clf ~PCi ,-, r~!. Y TO Till~ FO!\M 0/~ ANNO'rA TF. IHTH YOU/{ NAMf.7 T'OR lfJJ-:NTI f 'I C A T/ON . ) 2 WH t.T 'TIY~: :>YOU FIRST SI GHT TH!: t'Hi:.N0'1 F N O N ? 3 . V."iAT Tl\1:: _.,o YOU L AST SIGHT T H E P H E N OMENON? 4 . T I' A E Z 0 N E. [_] DAY Ll G H T SAVINGS (' j STAN 0 Ml D [IEASTE~-.. [_!CENTRAL l)MvUNTAIN [jPACIFIC [_jOTHER 5 WHER~. ~e,o;:;:_ YOU WHEN YOU SAW THE PHENOMENON1 I F IN CITY. G IVE THE NEAREST STRFET ADDRESS AND INDICA n: ON A Ht\'l:> 0-,\t~ MAP 'IIHE~E YOU WE'RE STA"lDING WITH R EFERENCE TO THE A DDRE::!>S. IF IN THE COUNTRY. IDENTIFY THE riiGI-I'NA'Y Y::J WERE ON 0R NEAR AND T~V TO FIX A DISTANCE AND DIRECTIO N FROM SO M E RECOGNIZABLE LANDMARK. J A ~ E AT T H E P 0 I N T S H 0 h N I N T 1--4 E S K ETCH , P L A C E A N -A ' 0 N T H E C U R V E D L I N E T 0 S H 0 W H 0 W H 1 G H T H E P.-C'IC"'::-..-:.~ liAS ABOVE THE HORIZON, OR SKYLINE. WHEN F IRST SEEN. PLACE A a~ ON THE S AME C:URVEO LINE TO S~'),.. L.l;),o~ ~ 31-f ABOVE THE HORIZON TriC. PHENOMENO N WAS WHE N LAST SEEN. OBSEPVER .., AFit HO-J7(Cl) fJA. NOW 1'..1AGINE Y O U J\~E ATTHE CENTI:'R OF 'iHf: COMPASS RO~'':. PLACE AN.,. .. O N ntE COMPASS TO INOICATr THC [\IH.:C.TIO N TO TH:.. PHENOMENON WtiCN FIR~T SFEN. F"LAC .. E A H ON THE COMPA~S TO INOICATI THl:. Dtr~l:.CTION TO r H L: P tl f;, N 0 M E N C' '-tr H F. N L AS T S E E 1'1. i. 1~. T"i=: SI":ETCH ::?=:LO'rl, PLAC E AN A A T THE P O SITIO N OF THE PH=:NOMENON WHEN FIRST SEEN, At~O A s AT THE POSIIIO'~ O F T'iE ::>nENOMENON WHEN l.AST SEE"l COr-INECT THE .. A. AND a WITH A LINE' T O A P PROXIMATE THE h' .::.V:!M:NI C F 7 '-':::: ~HENOMENON BETWEE N "'A " AND"~". THAT IS, SCHEMATICALLY SHOW WHETHER T~IE MOVEMEtH .t.~;:,E.;?.=:D TO SC:: :;TRAIGHl', CURVED OR Z I G ZAG. REF E R TO SMALLE R SKETCH AS AN EXAMPLE O F HOW T O COMPLETE PAGE 2 OF 9 P A G E!=. AFR R0-17(CI) \; OUTDOQq 5 IN BUSINESS SECT I O N OF CITY IN O UIL:J' G IN R E.SID!:::N T IAL SEC T I O N OF CITY I 0 A S DRIVE R 0 A S PASS~N GFR OPEN COUN T R Y SI fiE N E A R AIRFIELD 0 A S P ILOT [j A S PASSEN G E R FLYING OVE R C I T Y FLYING O V E R OPEN C O U NTRY A . I F YOU WER E I N A VEHICLE, COMPLETE THE FOLLOWING : WE R E YOU MOVIN G H O W F A ST WE R E Y O U MOVI N G ? YOU STOP ANY T I ME WHILE PHENO M E NON' BSERVI N G EXPLAI N w,:::THER SU C H MOVE M E N T A F FECTS Y OUR SKE T C H C S IN ITEMS 5 AND 6 . OESC?.19 E -::: OF V EHICLE YOU W ERE IN A N D TYPE OF ROAD, TERRAIN O R BODY O F WAT E R YOU T RAVE R SE D DURING T H=: SIGHTING. STATE WHE THER WIN D O WS O R CONVERTIB L E WERE U P OR D OWN. H O W MUC H OniE R TRAFFIC WAS T HERE ' I I C I O YOU N:JTIC E ANY A I R PLANES? t" YES 0 N O . ES," D E SCRIBE WH E N THf- Y WERE IN SIGH T R ELAT I V E TO THE .) F 5 I ~ Y T I N .:; THE P H ~ N 0 M E N 0 N AN D W n ERE THE Y WERE IN THE SKY R ELATIVE TO T H E POSITI O N O F T H E PHEN O M E NON. HvW LONG WAS THE PHENO NON I N SIGHT? CERTAI N O F T I M E OT V ERY SURE FAIRL Y CERTAIN JUST A GUESS wETERMIN EO? SIGHT c c .. -,...;uOUSLY' IF "NO," IND I C A T E WHETHE R THI S I S DUE TO YOUR MO\I~'..AE:H 0=' T H E BEHAV I O R OF ;;-' YE: rlEN0~.4ENON, AND DESCRI}'E SUCH OVEMENT OR B E H AVIOR . ATE DISAP. PAGE 3 OF 9 P AGES 10. I F THEnE WERE MORE TH~.N ONE PHENOMENON, HOW MANY WERE THERE' AHRANGEO. DID THIS APRANGEM!:NT CHANGE DURING THE SIGHTING' DRAW A PICTUHE TO SHOW HOW TI4EY WC R E CONDIT 10 NS (CIa ec k appropriute bloc lcs .) DAY CUMULUS CLOUDS (/,o w fluffy) FOG OR MIS T / THILIGHT CIRRUS CLOUDS (/lie,\ fleecy or llc rring HEAVY RAIN \/ Jl!lGHT bone) LIGHT RAIN OR DRIZZLE PARTLY CL~'JOY CUMULONIMBUS CLOUDS SNOW OR SLEET OMPLETf.:...Y OVERCAST (Thunderstorms) UNKNOWN C . IF THE SIGHTI/'ol(; WAS AT TWILIGHT OR NIGHT. WHAT DID YOU NOTICE ABOUT THE STARS AND MOON? I N FRONT O F YOU TO YOUR RIGHT OVERHEAO(NeMnoo~ IN BACK OF YOU T O VOUq LEFT !:'. S"E C IFY THE MAJ O R SOURCE OF ILLUMINATION PRESENT DURING THE SIGHTING, SUCH AS THE SUN, HEADL I GHTS OR S'iREET ~A_. .-ETC. FOR)TERR ES,,RIAL ILLUMINATION, SPECIFY DISTANCE TO LIGHT SOURCE. GIVE ~ B R iEF D:.SCRIPTION OF THE PHENOMC:"40i-l, INDICATING WHETHER IT APPEARE D DARK OR LIGHT, WHETHF.R IT REFLECTEO L!C OR WAS SELF-LUMINO:JS AND WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER IT WAS SOL!O 0;1 ;~ANSPARENT, WHETHER ::OGES WERE SHAR P OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT AP? .=: "R ~ 0 A S A POINT OF LIGHT. IN OICA T E COMPARISONS WITH OTHER OBSERVEO""~OBJECTS, LIKE STARS, A LIGHT OR oTH::~ o=J Ec -I N YOUR FIELD OF vtEw. / " ~ / PAGE 4 OF 9 PAGES 010 THE PHENOMENON YES vN O VE I N A STRAIGHT LIN~? \,/ STANO ST I L L AT "NYTIME? v ,/' SUDDENLY SPEE:O UP AND RUN AWA Y ? \ " CHANG C OI..v~' v CHANGE: a Pt~'""TNESS? \./ . / v FLASH 0~ F-I:KER ? / OI SAP?E~R ~"1:> R E A P P EAR' V SPIN LIKE: A TOF'? V , /"" FLUTTER OR WOBBLE? \1 14. WHAT C RE'r YOUR ATYENTlON TO THE PHENOMENON' A . H O W 010 IT FINALLY DISAPPEAR'? PAG E 5 OF 9 P A GES 17. 010 YOU 08~ERVE THE PHENOMENO N THROUG H TYPE, FIL T~A. LENS PRESCRIPTIO N OR OTHE R ANY OF THE FOLLOWING' INCLUDE APPLICABLE DATA. A}_,R RO-t 7( Cl) INf'ORMATIO N O N MODEL, SUNOLASS::S BINOCULARS WINOSHIE'- 0 ' T EL~SCOPE SlOE WINC'~N OF VEHICLE THEODOLITE WI NCCW=A...:,: / OTHER _/_ 18. WHAT W>.S ':':t..~ IMPRESSION OF THE SPEED OF THE 19. WHAT WAS YOUR IMPRESSION OF Tl-iE DISTANCE QF ;THE PHENOVE'':'I -i -:-otVE-Ef'IJI'MATE OF S D..., ~ t PHENOME"NON' GIVE ESTIM.\TE OF DISTANCE L~ l~ L~ . 20 IN ORO:~ Tt"AT WE MAY OBTAIN AS:t:LEAR A P~tTURE AS POSSIBLE OF WHAT YOU SAW, DESCRIBE IN YOUR OWN WORD~ A C OM\o!O.._, ~QJE C T OR OBJECTS WHICH, WHEN PLACED IN THE SKY. SIMILAR TO WHERE YOU N O T E D T~E PHE N O M E N O N , WOULD BE.A~ SOME RESEMBLANCE T O WHAT YOU S AW. OESCRIB~ SIMIL{'RITIES AND DIFFERENC /BETWEEN THE COMMON 09JECT AND WHAT YOU SAW. ---- - ~ I ::. t C Y~U "iO - I::E ANY O DO R , N O ISE. O R HEAT EMANAT~ FROM THE PHENOMENON OR ANY ANI\tAL3 o,-MACHINERY IN TH~ VICirJITV 0 YES M NO. IF yEs, DESCRIBE. EFFECT m~ YOURSELF. A . DID Tl-IE P ~-~.:~DISTU RB THE OUNDOR LEAVE ANY P H YSICAL EVIDENCE. QY E S "f\lNO. PAGE 7 OF 9 PAGES 22. HAVE YOU EVER S EEN THIS OR A SIMILAR PHl:NOM ENOH BEFORE? LOCATIO N . ' ES ( ] HO. IF YES, .. GIVE DATE A,...D 21. WAS ANYONE WIT~ "O'.J A T THE TIME YOU SAW THE ,Hf:NOMENON' YES 0 NO. IF .,YE:s. DID THE Y SEE IT TOO? 0 YES 0 to~C. GIVE THE FOLLOWING INFORMATION AAOUT YOURSELF AND ANY EXPERIENCE WH I C H MAY BE PERTINENT. 25 WHEN 0.:-1 C 7 0 ,'1:-:.~;:::; ':"~U Rt:PORT T~AT YOU HAD SIGHTED THIS P H E N O M E NON? 26. Ct ATF YO~I -:;o,..;:.L=::- THIS QUESTI O:-INAIRE. P AGE 8 OF 9 PAGES U. IN'O"MATIOf't WHIC'4 YOU ,EEL IS PRTINENT BUT WHICH IS UOT ADEQUATELY COVEPU:O IN THIS QUESTIONNAIRE, ALTI"NATIV~LY PROVIDE A NARRATIVE EXPLANATIO N F THE SIGHTING. ' PAGE 9 OF 9 PAG E S TD?'T' (UFO} DEPARTMENT OF THE AIR FORCE HIEADQUA"TIUtS F'OfltEIGN TECHNOLOGY DIVISION f A'SC) WRIGHT.PATTEA90N Alflt F'ORCE I!IA9~ OHIO 4!5433 U?C Sbservatio:1. Yet::-nnme has been given to the Aerial Phenomena Office (Projec t Blu e Book) as being a ~itness to an unidentified flyin6 object. If you ~ere a witness to un UFO sighting on .. ould you please complete the ottnched AF Form 117 and return it in t.he envelope provided. If you \-:ere not a vli tnes s to this sighting , ~oul~ you please ~ake a sta t ement to this effect on the ~:t.:.uched form. The information 1t:hich you provide will b e used in c.-.. tlu'ltint; this observc.1tion. Thunk you for your assistance in this l f..ZCTOR ~UINTJ\NILL4 Jr, Lt Colonel, USAF AF Form 117 w/envelope Chie!', Aerial Phenomena Office ~erosp~ce Technologies Division Pr~cuction Directorate IWDt;,.; T I IUREAU Al'l'ltoVAJ. NliM/If:R 2f-R258 SIGHTIHG OF UNIDENTIFIED PHEHOMEHA QUESTIOMMAIRE Till~ (,>\IESTlO:'olNt\lRE HA~ HEEN Pl~El'AREO ~ TflAT YOU CAN G IVE Tf-11-: U. S All~ FOI~Cfo: AS MlJCif JNFOI~MATlON AS I'()SSlBLF CO~CE"NtNG TfiE UNIDENTI F IED f'JIENOMI!:NON TlfAT YOU 111\Vfo: OtlSERVEl >. P LEASE Tf{Y TO A!'lS\H:t~ 1\1 L 0 F T H E QlJF.STIONS. Tilt~ INFORMATION YOU G IVE WILL H E USED FOI~ IH.SEAf~C' ll PURPOS E S YOUJ~ N,\:\lE \\ i L \ . NOT OF. USED I N CONNECTION WTTll ANY OF YOUR STATEMIO:NTS Of< CONC LUSIONS WI T HOUT \'OUt~ Pl.R~11~:--Icf~. WETlll{N 1'0 AIR FOI~CE BA~H;: I N VESTIG ATOR FO~ FOI~WAl~l>lN(i TO FTil (TI>ETJ~). Wf~lCliT PATTER~O~ t\t:B. OHI0-15433,1f\W f\FRAO-f7. (TF A D I>I'I'IONI\L SIIEI-;T S AI?T; NI!.EDJ~I) FOR NI\NUI\TIVF. OJ? S/<I~TCJIT~S A T1' .. 1Cfl ::.FCT r:FL Y TO TillS FOU M nu ANN01'A1'f': JH1'11 l'OUI~ NAMR f"OT~ lf)I~NTIPICAT/0!\'.) 1. WH"' :>ICJ ";:>.;SEE THE PHENOMF.NON DID YOU FIRS T SIGHT THE PHE:NOMFNON't 3 . \HIA-T l '.':. 010 Y O U LAST SIGHT THE PHENOMENON? 4 . TIM!:. ZO~: I OAYLIGHT SAVINGS l J STANDARD [}EI\STE .. '"-l [_!CENTRAL [)MOUNTAIN []PACIFIC [!OTHER