2. LICATIGM I owa City , I owa t . N\lM~f" M OIJ!Cn 5. LENGTH OF OIIE"VATIOH t.. TYPE OF OBSE"VATIOH Gro1:1d-Visuul 1 , COURSE 9. PHYSICAL EVIDIMCl 11. CONCLlNOM Probable ( SATELLI TE) Discription is consistent with tha t of a satellite. observer s i ghted a star- like li{)lt. t:.hat moved accroGa the sky and disappeared in about 10 minutes. He indicated on t he creen 164 that s ightinG occurred at 6 : 00PM b u t on the AF For m 117 he indicated that it occurred a t 8 : 00PM. DID THE PHENOMENON MOVE IN A STRAIGHT LINE' STANO STILL AT ANYTIME SUDDENLY SPEED UP AND RUN AWAYl BREAK UP IN PARTS AND EXPLOOE1 CHANG!! COLOR ' GIVE OFF SMOKE CHANGE BRJGHTNESS7 CHANGE SHAPE FLASH OR F L I CKER! DISAPPEAR AND REAPPEAR' SPIN LIKE A TOP 7 MAKE A NOISE FLUTTER OR WOBBLE 14 . WHAT DREW YOUR ATTENTION TO THE PHENOMENON? A . H OW 010 IT FINALLY DISAPPEAR {A)f ll( I")I.Y'r B . 010 THE ~OMENON MOVE BEHIND O R I N FRONT OF SOM ETHING , LIK A CLOUD, TREE, OR BUILDIN G A T ANY T IME! 0 YES 0 . IF "YES, " DESCRIBE . PAGES O F 9 P A GES 22. HAVE YOU EVER SEEN THIS O R A SI MILAR P H E N OMENO N B E F O R E ' 0 YES LOCATION . 23. WAS ANYON E WITH YOU AT T H E T I M E YOU SAW THE PHE N O MENO N ~YES {BYES 0 N O . IF "YES,~ GIVE D ATE AND N O . IF yEs. DID THEY SEE IT TOOt 2 4 . G IVE T H E FOLL O WI N G INFORMAT I O N ABOU T YOURSELF I NDICA T E A TIONAL INFORMATION INCLUDING OCCUPAT I O N AND ANY EXPERIEN C E WHIC H MAY BE PERTINENT. 25 WHEN AND T O WH O M DID YOU REPORT THA T YOU H A D SIGHTED THIS P H E N O M EN O N > DAY M O N T H YEAR 26. DATE YOU COMPLETED THIS QUESTIONNAIRE. DAY M ONTH P A G E B OF 9 PAG E S 17. 010 YOU OBSERVE THE PHEN O MENON THROUGH TYPE, F'IL TER, LENS PRESCRIPTIO N OR OTHER ANY OF THE FOLLOWI N G> I NCLUDE INFORMATION O N MODEL. APPLICABLE DATA . V EYEGLASSES C AMERA VIEWER SUNGLA SSES /./ BINOCULARS WI NDSHIELD TELESCOPE SlOE WI NDOW OF VEHICLE THEODOLITE WI NDOWPANE OTHER A . 00 'fOU OROIN ARIL Y WEAR GLASSES> l!2l YES 0 NO 18 . WH A T WAS Y OUR I MPRESSION OF THE SPEED OF' ;\.HE ) PHENO MENON > GIVE ESTIMAT E OF SPEED fhf\ f,~-JL' B . Ol) YOU USE READI N G GLASSES' 19. WH A T WAS YOUR I MPRESSION OF THE OISTANC~Of !E PHENOMENON> GIVE ESliMATE O F DISTANCE Lr1 l,l I N ORDER THAT WE MAY OBTAIN AS CLEAR A PICTURE AS POSSIBLE OF WHAT YOU S A W, DESCRIBE IN YOUR O WN WORo:; A COMM O N OBJECT OR OBJECT S WHIC H , WHEN PLACED IN THE SKY, SI M I LAR TO WHERE YOU NOTED THE PHEN O M E N O N , WOULD BEAR SOM E R F.SEMBLANCE TO WHAT YOU SAW. DESCRIBE SIMILARITIES AND DIFFERENCES BETWEEN THE COMMO NOBJECTANOWHATYOUSA, w./ I , 21. 0 10 YOU NOTICE ANY ODOR. NOISE. O R HEAT E MANATING FROM THE PHENOM E N O N OR ANY EFFECT ON YOURSELF'. ALS O R MACHINERY I N THZ VICINITY> 0 YES IL:d'NO. IF vES, DESCRIBE. A . 010 THE PHE N O M ENON DISTURB THE GROUND O R LEAVE ANY PHYSICAL EVIDENCE. 0 YES @'N O . IF yEs. DESCRIBE. PAGE 7 OF 9 PAGE S 27. IN'0"WATION WHICH YOU ,~EL IS P~,_TINNT IIUT WHICH 15 NO T AOf:QUAT~LY COV,.0 IN THIS QUESTIONNAIRE, ALTR,.NATIV~LY P"OVID~ A NA,.,_ATIV~ EXI"LANATIO N OF THE SIGHTING. F' AGE 9 OF 9 PAG E S U.S. AIR FORCE TECHNICAL INFORMATION This que~llonnoire ho~ been prepored ~o thot you con give the U.S. Air Force os much lnformotion os possible concerning the unidentified oeriol phenomenon thot you hove observed. try to onswor os mony questions os you possibly con. The information thot you give will be used for reseorch purposes. Your nome will not be used in connection with ony statements, conclusions, or publications without your permission. We request this personal lnformotion so thot if It Is deemed neceuory, we moy contoct you for further detoils. When d id you see the obJect? 2. Time of doy: {}eceg/:tl' ;qr;g (Circle One): A.M. or Ooy Month Yeor 3. Time Zone: One): o , ~ostern G! :-:~atiQO c. ountoln d. Pocific 4. Where were you when you sow the object? (Circle One): o . Doylight Soving Neoreu Postol Addrtu City or Town Stott or County 5. How long wos object In sight? (Totol Durolion) Minutes Seconds o . Certoin 5.1 How wos t:.F:ir:~:;::::rmlned? -~'l!!auW fJ'L!.lJ .Lt.'.fl.E:.~!._..1: a I? cl c A(' c Led .S.2 Wos object in sight continuously? 6. Whot wos the condition of the sky? o . Br:ght b . Cloudy o . Brig ht 7 . IF you sow tho object during DAYLIGHT, where wo s the SUN locoted os you looked ot the object? (Circle One): o . In front of you In bock of you To your right d . To your e . Overheod f. Don't remember FTO OCT 62 164 Thl form upenedes FTO 184. jul 61. which Is obsolete 8. IF you so w tho o b ject ot NIGHT, whot d id you notice concerning the STARS and MOON? 8. 1 STARS ( Circle One)! 8.2 MOO N ( Circle One): Bright moonlight Dull moonlight c. No moonlight- pitch dark on't re member d . Don' t remember 9. Whot were the weather conditions ot the time you sow the object? ClOUDS (Circle One): o . Clea r sky c. Scattered clouds d . Thick or heovy clouds 10. The o bject oppeored: (Circle O ne): b . T ronspo rent d . As a light WEATHER (Circle O n e): b . Fog, mist, or light roin c. Moderate or heovy roln e . Don't rernerl\btlt e . Don't remember 11. If It appeared os o light, wos It brighter thon the brghtest stan? (Circle O ne): o . Brighte r bout the some d. Don' t know Com pore brightness to some common object: d!Zd 1/l'/d;r 12. The edges of the object were: (Circle One): o . Fuu y or b lurred b lke o b ng h t star c. Sharply d . Do n' t remember 13. Did the object: (Circle One for each question) o . Appoor to stand still o t any time? Don't know b . Suddenly speed up ond rush owoy o t ony time? Don' t know reak up 1nto porh or explode? Yes Don' t know d . G ive off smoke? Yes Don't know e . Change brightness? Yes Don't know f. Change shape? Yes Don't know Flash or lliclcer? Don' t know Disappear ond reoppeor? Don't know ~UFO form continued 20. Do you lh in k you con oSiimolo lho speed of lho object? (Circle One) Yes @ IF you answered YES, lhen whol speed would you eSIImole? _ 21. Do you lhin k you con estimate how for owoy from you the object was? (Circle One) IF you answered YES, thon how for owoy would you soy it was? _ Whore were you locotod whon you sow I he objecl? (Circle One): o . Inside o building b . In o cor d In on oorplone (typo) e . At sea 23. Were you (Circle One} o . In lhe business secllon of o cily? b. In tho residonliol sec lion of o cily? c. In open counlryside? d . Neor on o irfteld? Flying over o city? Flying ov,.open country? 01her kYl t/1 t' (,\ oe J1 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle o t the time, then complete lho following queslions: 24. 1 What doreelton were you moving? (Corcle One) o . North c. Eosl e . South b . Norlheosl d . Soulheau F. Southwest h. Northwest 24.2 How lou wore you mavlng? miles per hour. 24.3 Dtd you stop o t o ny time while you were looking ot the object? (Ctrcle One) Ye s No Did you observe the objectlhrough ony of the following? Eyeglasses No e . Binoculars b . Sun glosses No f. Telescope No c. Wind1hield Yes No g . Theodoltte Wlndowglon Yes No h . In order thot you con g ive as clear o pic lu re as possible of what you sow, describe on your own words o common object or ob jects which, when plocod up In tho sky, would give the some oppeoronce os the object whteh you sow. . Official U.S. Air Force 14. Did the object d "oppeor while you were watching it? If so, how? object move behind something ot ony time, particularly a cloud? (Crrcle One): Don' t know. IF you answered YES, then toll what moved behind : object move In front o f something at a ny limo, particularly a cloud? (Circle One): Yes Don' t know. IF you answered YES, then tell what in front of: Tell In o few words the followong th ings about the object: o . Sound !).all Ct. We wish to know t he angular size. Hold o match stick or a rm's length In line with o known object and note how much of the object Is covered by the head of the match. If you hod performed thi s ellperlmonl at the time of tho sighting , how much of the object would have been covered by the match hood? Ot/ln 'f r: ~ n Draw o picture that will show the shape of the object or objects. label and Include In your sketch any details of the object that you sow such as wings, protrusions, etc., and especially uhaust trails or vapor lraols Place an arrow beside the drawing the d lrectoon the object was moving . Official U.S. Air Force I 27. In the follo wing sketch, imagine that you ore at tho point shown. Place on " A" on tho curved fino to show how high the object above the horizon (skyline) when you first sow it. Place a " 8" on the same curved line to show how high the object wos above the horizon (skyline) when you last saw lt. Place an " A" on the compass when you first saw it. Place a " 8" on the com pass when you loJI saw the object . 28. Draw a picture that will show the motion that tho object or objects made. Place an " A" at the beginning of the poth, a " 8" ot the end of the path, a nd show any changes in d irecti'5 during the coune. 29. IF there wos MORE THAN ONE object, then how many were there? _ _. _ p icture of how they were arranged, and put on arrow to show the d irection that they were traveling. JFO form continued 30. Have you ever seen this, oro similar object before. If so g ive dote or dotes and location . 31. Was anyone else with you at the time you saw the object? (Circle One) 31. 1 IF you answered YES, d id they see the object too? (Circle One) 31.2 Please list their names and oddrenes: Please g ive the following Information about your5elf: ADDRESS _ lndi<ate any odditlonollnformotlon about yourself, including any special experience, which might be pertinent. 33. When ond to whom d id you report that you hod seen the object? J2 /; IJ/v! Dec.e 111 her fPS f Ooy ~ Ytor TDPT (UFO) DEPARTMENT OF THE AIR FORCE HEADQUARTERS FOREIGN TECHNOLOGY DIVISION I AFSC I WRIGHT-PATTERSON AIR FORC E BASE. OHI O 4!5433 UFO Observation, 14 Dec 1968 Iova C1 ty Iowa 5224o Reference your recent unidentified flying object sighting which you reported to the Air Force. The information which we have received is not sufficient for a scientific investigation. Request omplete the attached AF Form 117 and return it in t he self- addressed envelope. Thank you for reporting your observation t o the Air Force. CTOR ~UINTANILLA, Jr, Lt Colonel, USAF hief, Aerial Phenomena Office Aerospace Technologies Division Production Directorate AF Form 117 w/envelope I FO form continued Official U.S. Air Force l 34. Dote you completed thii questionnaire: ;:., ' t. It. x /)ecem be r Oo Month Yoor Information which you feel pertinent and whic h is not adequately covered in the specific points of the questionnaire or o narrative explanation of your sighting. TDPT (UFO) DEPARTMENT OF THE AIR FORCE HEADQUARTERS FOREIGN TECHNOLOGY DIVISION I AFSC l WRIGHT-PATTERSO N AIR F O RCE BASE. OHIO <45<433 UFO Observation, 14 Dec 1968 wa City, Iowa 52240 Reference your recent unidentified flying object sighting which you repor ted to the Air Force. The information which we have received is not sufficient for a scientific investigation. Request you comple te the atta ched AF Fo r m 117 and return it in the self- addressed envelope. Thank you for reporting your observation to the Air Force. r, Lt Colonel, Chief, erial Phenomena Office Aerospace Technologies Division Production Directorate AF Form 117 w/envelope AFR 80-J7(Cl) 6A N O W IMAGINF YOU AilE "TTHE CEPITEP 0~ THE COMPASS R O'iE. r L ACE AN " A " ON THE COMPASS TO I~IOIC.ATE THE OIRECl ION TO THE PHENO~E NON WHEN FtnST SEEN PLI'CE A p ON THC COMPASS TO I NDICATE THE DIRECTION TO THE P H E N O MENON WHEN LAST SEEN . 7 . IN THE SKETCH BELOW. PLACE AN " A " AT THE POSITIC N OF' rHE PHENOt~rNON WHCN FIRST SEEN .C.'~D A e AT THE POSITION O F THC: PHEN O M E N O N WHEN LAST SEEN . CONNECT THE "A" AND " B ' WITH A LINE TO APPROXIMATE THE MOVEMENT OF THC PHEN OMENO N BETWEEN "A" AND " B " . THAT IS, SCHEMATICALLY SHOW WHETHER THE MOVEMENT APPEARED TO BE STRAIGHT, CURVED OR ZIGZ.AG. REFER TO SM.ALLER SKETCH A S AN EXAMPLE OF HOW TO COMPLETE THE LARGER SKETC H . PAGE 2 OF 9 P AGES SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE BUDGET DUREAU APPROVAL NUMDER 2 1 R2$6 Till S QUESTIONNAIRE liAS BEEN Pl~EPARED SO TIIAT YOU CAN GIVE THE U.!:' AIR FORCI: AS MUCII INFO~MATION AS POSSIBLE CONCERNING THE UNIDENTIFIED PHENOMENON THAT YOU HAVE OOSERVF.D. PLF.ASE TRY TO ANSWER ALIJ O F THE QUESTIONS. TilE INFORMATION YOU GIVE WILL BE USED FOR f~I-:SEARCII PURPOSES YOUR NAI\IE WlLI,-NOT 13E USED IN CONNECTION WlTII ANY OF YOUR STATE MENTS OR CONCLUSIO N S WlTIIOUT YOUR PERMISSidN. I~ETURN T O AIR FORCE 13ASE INVESTI GATO R FOR FORWAIWING TO FTO (TOETR). WRICIIT- PATTE R SON AFI3, OH I 0 45 433, I AW AFR 80-i7. (IF ADD/ TIONA L Sl-fi~F.TS ARF. NI~F.DF.D FOR NARI?A TlVI-: OR SK F.TCIIF.S ATTACH SF.CURF.L Y T O TfllS FOR/11 O R ANNOTATF. IHTH YOU/? NAMF. FOR IDF.NTTFICA T/ON.) I WHEN DID YOU SEE THE PHEN O M E N O N ' 2 WH "'T T I M E DID YOU FIRST SIGHT THE PHENO M E N O N ' 3 WHAT TIM E DID YOU L AST SIGHT THE P HENOM E N O N > HOUR '.-MINUTES 4 TIME ZONE IJ DAYLIGHT SAVINGS l J STANDARD [1 EASTERN 1 CENTRAL lJ MOUNTAIN IJ PACIFIC I 1 OTHER 5 WHER'i:: WERE YOU WHE N YOU SAW THE PHEN O MENON' IF IN CITY GIVE THE NEAREST STREET ADDRESS A N D INDICATE ON A HI\N D D"lAWN MAP WHE"lE YOU WERE STANDING WITH REFERENCE TO THE ADDRESS. IF' 1~1 THE (;OUNTRY, IDENTIFY THE HIGHWAY YOU WERE ON OR NEAR AND ANCE AND DIRECTION FROM SOM E RECOGNIZABLE LANDMAPK 6 IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE AN A ON THE CURVED LINE T O SHOW HOW HIGH THE PHENOMENO N WAS ABOVE THE HORIZON. OR SKYLINE WHEN FIRST SEEN . PLACE A 9' O N THE SAME CURVED LINE TO SHOW HOW HIGH ABOVE THE HORIZON THE PHENOM E N O N WAS WHEN LAST SEEN . OBSERVER ,.,. AFR R0-17(Cl) 10. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WERE ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING? II. CONDITIONS (Citeclc appropriate block s . ) B . WEATHER DAY CUMULUS CLOUDS now fluffy) FOG OR MIST TWILIGHT CIRRUS CLOUDS (Hif(lt fleecy or Herrinc HEAVY RAIN V NIGHT bone) LIGHT RAI N OR DRIZZLE 1/ CLEAR NIMBUS CLOUDS (Rain) HAIL PARTLY CLOUDY CUMULON IMBUS CLOUDS SNOW O R SLEET COMPLETELY OVERCAST (Titunders t orm.s) UNKNOWN C . IF THE SIGHTING WAS AT TWILIGHT OR NIGHT, WHAT DID YOU NOTICE ABOUT THE STARS AND MOON ' Ill STARS 121 MOON NONE BRIGHT MOONLIGHT NO MOONLIGHT A FEW MOO N WITH HALO V UNKNOWN D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLEl 0 YES 0 N O . THE PHENOMENON? IF "YES, " WHERE WAS THE SUN A S YOU FACED IN FRONT OF YOU TO YOUR RIGHT OVERHEAD(Ne~noo~ IN BACK OF YOU TO YOUR LEFT E . SPECIFY THE ... AJOR SOURCE OF ILLUMINATION PRESENT DURING THE SIGHTING, SUCH AS THE SUN, HEADLIGHTS OR STREET LAMP, ETC. FOR TER~ESTRIAL ILLUMINATION, SPECIFY DISTANCE TO