LENGTH OF 03SERVATION Vt OaS~RVATION PHYSICAL EVIDENCE 3RI E F SU.\t: .. IARY AND ANALY SIS 23 WAf. M~Y.::>'~ E WITI1 YOU AT n1 E TIME YOU SAW THE PH ENOMENO~P ~J YES 0 NO. IF vES, .. Dl 0 THE Y :E IT TOO' 0 Yt:.S D NO. A. LIST 7HEIR NAMES AND A DRESSES GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF INDICATE ADDIT 0NAL INFORMATION IJ:ICLUDING OCCUPATION AND A~Y EXPERIENCE WHICH MAY BE PERTINENT. l>.ND T O WHOM OlD YOU R EPORT THAT YOU H A D SIGHTED Tl-I!S ?nENOtlotENON7 "'0~ C OM?LE7EO THIS QUESTIONNAIRE. P A G E 8 OF '3 PAGES ';7'0~:;;;,~-;. fiOH WHICH vou FEEL IS PR AFR !10-17( C\ l PLANATION OF THE SIGHTING. THI, OUESTIONNA.IHE , AI..T!~NATIV~I..Y PROVIDE A. NARAA.TI:~N;~T BUT WHICH IS NOr AOEQUA.TELY COVCREO IN ,.. /l:~,J;if/1NAi PAGE 9 OF 9 PAG E S T DPT ( ill"O ) OEPARTMI!NT OF TH!: AlA FORCE )o4AOOUA~T=:Ff~ f ORCION TF.:C t-4NOLOGY DIVISIO N I ,\FS C I UFO Observation ch~r, Ohio 45326 Reference your recent unidentified flying object sighting which you reported to the Air Force. The information which ve have received is not sufficient for a scientific investigation. Request complete the attached AF Form 117 and return it in the self- addressed envelope. Thank you for reporting your observation to the Air Force. ')-.!-~CTOR 'c(.UINTA~ILLA, Jr, Lt Colonel, Chief, Aerial Phenomena Office "' Aerospa~e Technologies Division Production Directorate AF Form 117 w/envelope n;g PH ~O'.E O~l 'Nt-i!;.N LAST St:CN. IN TH:; SKETCH BELOW, PLACE AN "'A'" AT THE POSITION OF THE PHENOMENON WHEN Fl RST SEEN, AN 0 A .. s AT THE P')$1710"1 o : THC PHENOME'IO;~ WHEN LAST SEE'-~ CONNE C T THE .. A,. AND a WITH A LINE TO APPROXI~-IATE THE MO'/C:M ENT OF THE PH ENOM'::NO N BETW!::EN A'" AN :l "13 . THAT IS, SCHEMATICALLY SHOW WHETHER TH !:': "40V E t,. ENT APP:;,\r!0 TO 9E STRAIGHT, CU~VEO OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW Tv COMPLETE ARGE? SKETCH. PAGE 2 OF 9 P AGES lJUDfii-:T IW'lEAU APPROVM. NU.W/Ji~'.? 2l RHI SIGHTING OF UNIDENTIFIED PHEHOMEtfA QUESTIO A1RE l'llh <,'tlESTlO!'-;NI\IRI liAS llt-: E:'J i'l~l-Pt\l,l'r1: 'l THA r YOI' C \~ GI\'E TilE U ~ At~ HH~CE 1\!:i MllCff J'\'101<\tt\1 f0:'-1 t\~ PO~SIIJLE CQ,:,:t-: 1~:-itNG THI: t ''lDFI'TliIFD PtiL~0\1E.~C""' TIII\T YOU HI\VE OBSERVED l't.r: I\ S l: TI~Y TO ,\;-.;~\\EI~ \LU OJ-Til QlJF.STlO THE l\;f ''lRMt\1'10~ "lOl (~lVE WILL H E USED IOH tH:SFAPC'H PVRPOSI.S YOU k ~ A~tE \\tL\~ NOT BE US E D 1~ CO'.; 'i ECTIO~ \\1'1'11 A~\' OF YOUR ST 1\TEMENTR OR CONC LUStOS:; WITHOUT \'()t'~ P 1:1-!:\U !'~IdN. H ETURN TO Atr~ FOI~C E nA:;t:: tS\ l:.STIG \TOR FOR FORWAI~DING TO FTO (Tl>ET~). WR IGHT- I' AT fEI\SON AFB, OHI O 45433, 1/\W Arf~ f\').17. ( f F ADDlTlO .\'.\l. 3!/EF.TS ARt: NI<;,.;OI~I) 1-'0/~ NARTU\ T/VE. OR !\KF: T C Tfi-:S \ T f . I C/1 SI-:CVUJ: L l ' TO TiltS FORM ON ANNOT~\TF. IHTH YOt'i~ .\'1\.\fF. FOr? IOF:NTTF I CATJON.) l WHEN 010 YOlJ SEE TH F PH f. N O M ENON 7 2 WH \ T riM~ 010 YOU F I R!JT SIGHT THE PH ENO~ENON J WH.; i TIME OlD YOU LAST SIGHT THE P~.iENOMt:::NON' / 4 . 71 ~.r....-ZON E [ ~6 AYL IGH T SAVINGS ( -j STAN DARO [:./ .. ASTERN [j CENTRAL [J MOU N T AI~ ~ j PACIFIC [] 0 fHI:::R 5 ,.,.H ~R:: WERE YOU WH C:N YOU SAW T~ E PH ENOYENO N ' IF I N CITv G VE THE N EAR EST S fRE ET ADDRESS AND INDICAn: ON A Hi\N D DRAWN MAP \'/ H ERE YOU WERE' STANDING WITH REFEREr-;C E TO THE ADDRESS. IF IN THE COUNTRY. IDENTIFY THE HIGYWAY YOU WERE ')N ()R NEAR AND TRY TO FIX A OISTANC~ ~D DIRECTION FROM SOM E RECOGNIZABLE. LAND'.4ARK. 6 I'' At;;tlll!:=" YOU AR~ AT THE 01NT SH~NN 1'1 TH~ SKETCH. ~LA::E A"' ;.. ON THE CURVED LINE T O SHOW HOW H'GH THE p .. H::N0\1~0N WAS AB':>VE THE H QqiZO'I. O=t SKYLINE N._.E._, Fi~S~ :;EEN. PLACE A (3 .. ON THE SAME CURVED LINE TO S!-JO'o'. HOW HIGH ABOVE THE HORIZON TYE PH~NOMENON w;..s '1>/...JE'I L ~ST SEEN . V.JI-I'~RE \q::RE YOW \'/~tr_.,..l YOU SAW T~i:: PH~I-tCl.<~-:: 10~'1 I N ~OAT I NEAR AIRFIELD IN AIRPLANE 0 A S PILOT f' 1 A S P A~SENGC R ' FLYING OVE R CITY FLYING OVE:.R OPEN COUNTRY IF YOU WERE IN A VEHICLE. COMPLE T E THE FOLLOWING WHAT OIHECTION WERE YOU MOVING" HOW FAST~ERE YOU MOVING? N O R THE 1\ST NORTHWE3 T WEST DID YOU STOP Af'1YTIM E W~ILE OBSE RVING THE SOUTH EAS T SOUT~WEST !,? Y E S 1'.! tiO EXPLAIN WHETHER SUCH MOVEMENT_ AyF I:.CTS Y OUR SKETCHES IN ITEMS S A~O 6 . DESCRIBE TYP~ OF VEHICLE YOU WERE IN AND TYPE OF ROAD, TERRAIN OR BODY O F WATER YOU TRAVER 5E':J DU"'IN(; THE SIGHTING. STATE WHETHER WINDOWS O R CONVERTIBLE TOP W E R E VP OR DOWN. / , itS':/ .S: ~ hrci HOW Mlft~..r 6fHVTRAFFIC WAS THERE? ------- ._D_I_D_v_o_u_N_OTICE A N Y AIRPLANES? 0 v :::s o. 1 F "YES, " OE.5CqlsE WHEN THEY WERE IN SIGHT RE_L_P._T-IV_E_T_O_T H_E_T_'_'';_- OF SIGHTING THE PHENOMENO N AND WH:::RE THEY WERE IN THE S"<Y RELATIVE TO THE POSITIO N OF THE PHENOME.NON . 9. HOW LONG WAS THE PHENOMENON IN SIGHT"~ !, C".S"RT AIN O F TIME LENGTH OF T IME NOT VC.~Y SU R!:: HOW W ,\S TIME DETERMINED? WAS THE. PHENOMENON IN SIGH T CONTINUOUSLY' QYES J2f'No. IF "NO.' INDICATE 'NHE THER THIS IS OUE TO YOUP MOVEMENT OR THE BEHAVIOR O F THE PHENOMENON. ANO DESCRIBE SUCH MOVEMENT O R B:::HAVIOR . l "lOICATE D IS"-P AVH ~0-l'l(Cl) i 1 CONDITIONS (Ch~ek appropr ia t e bluclu.) St< y e . lEATHER j DAY CUMULUS CLO U DS (Low / l ll.J[y) !1/ FOG O R MIST 1 C LF..A R NIMc3US CLOUDS fRnir.) H A I L J / PARTLY CLOUOY CUM ULONIMBU S C LOUDS SN O W O R SLEE T ! CO~PLETELY OVERCAST (Thu.rtd~rstorms) U N K N OWN fc. IF THE ~IGHTING WA~ AT TWILI GHT OR N i GHi. WH A T 0 10 YOU N O TtCE A BOUT THE S T A RS A N D MOON? ' i1l STARS (2) . MOON 9RIGHT MOONLIGHT ~ N O MOONLIGHT OON WIT H H~LO I F Sl~HTING WAS IN DAYLIGHT, THE PHEN OMENON? OON HIDDEN PARTIAL( ) WAS THE SUN VISIBLE 7 0 YES 0 NO. I F "YEs, WHERE WAS THE SUN A S YOU FACED ~ I 11'1 FRONT O F YOU TO YOU~ RIG"!T OVERHEA D (NP.tu noo r.) 11-l SACK OF YOU TO YOU R LEF T C:. SPECI!='Y T H E MAJOR SOURCE OF ILLUMINATION ::t RC::SENT DUR ING THE SIGH TING , SUCH AS T H E SUN. HEADLI GHTS O R TRE?. T LAMP, ETC . FC.~ TER TRI A L I L L U MINA ;J-9N . SF'ECIFY DlS T A N C E T O LICH T ~OURCE. GIVE A 9RIEF OESCRI?TION OF THE PHENOMENON, INDICATING WHETHER IT APPEARED OACfK OR LIG HT, WHETHER I T REF LECTED LIGHT OR WAS SELF- L UMINO U S AND '.VHAT COL ORS YOU NOTICED. DESCRIBE YOUR IMPRESSIO N O F WHE THER IT WAS SOLID OR TRANSPAPENT. WHETHER E D G ES 'HERE SHARP O R FUZZY. DESCRIBE THE SHAPE O R INDICA T E IF IT A PPE t.o.R E D AS A POINT O F LIGHT. I N OICATE COMPARISO NS WITH OTHER OBSERVED OBJECTS, LIKE STARS. A L l GHT OR OTHEM OBJECT IN YOUR FI!:LO O F VIE'N. ?/ PAGE 4 OF 9 PAGeS N O UNKtlOW'I t Oil:> THE PHENOMENON ST ~NO STILL AT ANYTI~t' AWAY ' lo'' BR! ' \( :.J~ IN PARTS AND EXPLOOE' CHANG E COLOR? GIVE OFF SMOI<E CHANG E B A IGHTNESS' CH '\NGE SHAPE? F LAS~ O R frLICKEA? 0 15 ~PPEAR AND REAPPE AR' SPI N L I K!:: A TOP? MAKE A NOISE' F L UTTER OA WOBaLE' 1 4 . WHAT DREW Y OUR ATTENTION JO THE PHENO t-4ENON?