PROJECT 1C073 ~ECO~D i o HliMgE~ OF OlJ:CTS LD-iCTH OF O~SE~VATION l>. T 1? E OF 03Sc ilVA TICtf 2o LOCATION 10. CONCLUSION Insufi'icicnt Data 11. i3RifF SU.I-IMARY A~ A>4ALY31S COi!?S:rJ.'3: The obs(:rver did no t provicle tl~ date o!' the obse:-va7.io::1. NOTE: Th~ observer jos 13 year3 old. ( Zrco..._, Atudurwal l W \ t K H U ) U.S. AIR FORCE TECHNICAL INFORMATION questionnaire has been prepared so th a t you co~ give the U.S. Air Force os much nformation as possible concerning the unidentified aerial ph~nomenon th o r you hove observed. ease try to answer os many questions as you possibly con. The information tho r you give will be used for research purposes. Your name will not be ust!d in co nnection with any stateme nts, conclusions, or publications without your poi!rmission. We request th is pet1onal information so that if it i~ d-1emed r1ece ssary. we may contocl )-OU f:.r furthe, d etails. Whe, did you see t he object? 2 . Time o f day: Ooy Month Y8or 3. Time Zot1e: (Circ/8 0f1e}: o . Eastern b. Cef1trol c. Mountoi, d. Pacific (Circle One}: ( Circle O n e}: o . Daylight So.,ing b . Standard 5. How lo ng o.s object in sight? (Total Duration) Mnures S&cond o. Certain c. Not v&ry sur~ d. Just o g ue\S b. rcoriy certain 5 .1 How wcs rome in sigM der')rmined? 5.2 Was obi<KT in ~nr C;)I"III1UOUSI;t? 6. 'Nhot was rhe c:lnoito,. Of >''! 1:Cy? b. c :ouov o. 8 riqht !>. Cloudy 7. IF you ,ow rl-e oo -:cr :;..,r<'g ;)A fLIGHT, wh<!re wos rhe SUN locat"d as you looked a t the object? (Circle One , o . In i-,nr oi OV d To your lehl,..--- c. To your c;nt f. Don't rem~mber FTD OCT 61 164 Thi~ Co rm 'upervtl.-s f'TD lli4, JU\ 6\, whch 1< ''""'IPte 8. IF you sow the objolcl a t N IG 8 . 1 STA?.S (Circle On>!}: o . None d. Don' t rernember 9 . What w":!re th u weorher cone CLOUDS / Crcle On"): o . C lear l ky._- c. Scattered clouds d . Thick o r heavy claud1 10. The ob1ect oppt!ored: (Circl~ b . Transparent 11. If it appeared a s o lighr, was a . 8rtghter b . Oimm~Jr 11.1 Co mpare brighrno>s to s 12. The edges o f I he o bjec I w~re: (Circle On~): a. fuu y or b. Like o bri Snorp ly c 13. Did the obt.,o;t: a. Apoeor tr, \ lo11d ~till or or b. Suddenly ~peed up ond r c. Breo'< up inro pot~ 01 I>Xf d Give off smo'<,.? e . Change "'''JhtN<~., ~ f. Chonq ,hop:' g Flash or 'l~<~'rt h. o.,cp~or or>J ,. :~ppuur' 8. IF you sow rh~ o b rect a t NIGHT, wha t d id you notice concerning rhe STARS and MOON? 8 . 1 ST S (Circle One): 8. 2 MOON {Circle O ne): a . Bright moonlight b. A fe w b. Dull moonlight c. No moonlight-pitch doric d . Don' t remember d . Don't rememb..tr ~. What wotra rne wuother condotian~ or the ,.,. you sow rhe ab1ecr'? ClOUDS, Circle One): THER (C~rcle One/: a . Clear slty,. - b . Fog, mist, or light roon Scotrered clouds c. Moderate or heavy ra in a . Thoele or hotovy cloud s d. Snow e . Don' t remember ihe ab1ecr appeared: (Circle 9,!!!J.;l------ --!-" --f ~l 0. SoliaL ----d. A s a light e. Don' t remember b. Tronsocrent 11. If it opoeor!fd as a light, was it broghrer rhon tne brightest stars? ( Circle Omt}: a . :!roc;hrer c. Abour the sam~ d . Don' t know 11. 1 Con-pore brighrneu to some common obiect: 7'-s ecc;es :T ... ., c o ree: were: ' C.rcre ;;, .. , " rJ::y or blurred~ o Loee o brg nr ~ror : . :inor?ly our.ne c c : o n 1 reme:noer 13. Dad lne ?O<K::O (Corc/11 Onll for each question) ::1 .l.o? eor r-: "end wll o r any ltme? o. 3uo Cfl'"'' ;o.,,., 1,10 o nd ru\ h a way o r any rome? .:. 3reo< uo n o<: :lOr!\ or explode? f. C!-lonc;e 1noo.,> h . Oosoppeor one r CJppP.or? Don' rlcnow Don' t lcnow Don' t lcnow, Don' t t.norl"' Don't '<no r No~ Don 1 know Do n' t kn~t f.,&l J a f"' .,t(. Don' t kno Offjcja1 U.S. Air Forc.e :UFO form c (C~rcle Oner. No.,._-Don't know. IF you onswer'ld YES, then tell ... hot 16. Did ~""object move in front of ~om .. tning a t any ti,.,e, ponicvlorly o cloud? (r;:,rcle Orte): Y<ts N~ Don' t know. IF you answered YES, th .. n tt'll whet 1. : 7, >ell in a =ew .,.,,ds the fo llowong things ooout rn:= objecr: 18. We wish ro '<'1ow rhe angular size. Hold o morcn stick at arm's length in lin with a known ob1ecr ond note how much of the oojecr is covered by rhe head oi th8 march. If you hod prformed rhis exp1:rlmenr a t tho time of the sighting, how much of the ooi~r would hove bee" covered by the march heed? 20. Do you thon< you can -stoma (Corel On~J IF yr.~u ons .. ~r~d v:s, rh.,n 21. Do you non!< you con .. ,hmo I ( ire/" On Cor c/o> Oni'l o I Mod,. 0 buo1donq b In o cor c Our..foo" ~ d '" "" oorplo,.-ryp-l 24 2 How fool Wtlr't you mo o . Eyeq.ou.a In aroott '""' y-:.u c.:: ' !ow much or tne t'!J, how mucn or o . 5 o r he object ,td" me dra wing Do you think you con estimate the spettd of the objecr? ( Cirde One) Yes v--No 21. Oo you rhink you con esrimote how for a way from you th e objecr wos? (C irde Onr.) IF you answered YES, then how for away would you say it was? Where were you located when you saw rhe object? (Circle One): Insid e a building b . In a cor c. Outdoors~ d . In on airplane (type) 23. Were you (Circle One) a . In the businttH section of o city? b. In the residential section of a city? In open countryside? d . Nea r on airfield? e. Flying over o ciry? e. At st.o f. Flying over opttn country? 2 4. IF you w.,re ,1.\0:,NG IN AN AUTOMOilllE or o th e r vehicle at th.t time, .then comple re th e follow in{questions: , 24.1 What direction we re you moving? (Circl e~)/_------- a. North c. East e. South Northeast d. Southeast f. Southw est 24.2 How fast were you moving? miles per hour. 24.3 Did you stop a t any time while you were loo king ot the objecr? (Circle One) Yes 25. Old you ob,erve the o~ject rnrough any o f the following? Eyeglasses Ye.y-No e . Binoculars Sun glosses f. T ~Jie"ope ndshield Y~s No g . Theodolite ). ::. Window g loss _ Yes No h. Northwest in c ro'.!r :~or you con giv., os dear o ;:,icrure as ponible of wno t you sow, d e scrib!.! n your o wn words o common object or ob 1ec~ wnicn, when ploc'!d up on It'd sky, would g ive the sorne appearance as the object wnoch you \0'"' Off~cial U~S. A1r Force UFO form iCl 27. In the following slcerch. imagine thor you ore at the point shown. Place on " A" on the curv'ld lin'l to show how high the object was above the horrzon (skyline) when you first sow it. Place a ''8" on rhe some curved line to show how high t he object was above the norizcn (skyline) when you fall sow it. Ploca on " A" on the compass when you first sow it. Place a "8" on the com pass when you icst sow the object. 'iJ"''" a picture t!1ot will show the marion thor rhe ocject or objects mode. Place on "A" o r th-l beginning of rho poh. o "8" or end of the path, and show any changes in dir9ction durinSJ 1!1~ course. IF there wa s MCR!: THAN ONE object, then how many w'3re there? ..;_ I"._ 1!.-----'---- Drow a picture of how they were orrlnged, and put on arrow to ~how the dirs,ion thor they were traveling. 30. Hove you .,ver s'l'ln this, oro 1 31. Was onyond elsol wrlh you o r 31. 1 IF you onsw<>red Y!:S, d 31 2 Plea~e li~t rh'!r no rr " or 32. Please grve TELEPHON= NUMB Indicate any oddirionol in rorr 33. When and ro .. hom ~id yov re rce UFO form contjnJ.iied 30. Hov~ you ~ver \eM this, o r o similar object be lor~. If so gi"e dote o r dotes end locatio n. 31. Wos anyon<! else with you ot the time you sow the object? (Circle One) 31.1 li' you onswer~d YES, did they see the obrect roo? ( Circle On~) Yas 3 1.2 Pleose lisr their names ond addresses: 32. Please g ive th e following information about yourself: f c., / 7ft.-. -~ ~..,; Zona Stal~ ony additional information about younell, includong ony special experience, which might be p ertinent . c".IC c; c I ] J . Dote yov complered m~ qveslionnoire: Monrh Year Day Information which yov feel poutinant ood which is oot adequately covered in the specific points of the quo~stionnoire or o ncrrotive explanation of your sighting. I AJ'R ''-I"!Cll An uJot-,.,,u l