P~OJECT 1~:.73 ~ECORD ! ~. LOCATION Jlo. CONCLUSION ~O'ItTitncss; not rctt~rncC.. af',.,~:c L ENGTH OF OBSERVATION '11. SRI cF SUMMARY AND ANALYSIS 'Observer called say~n6 he saw ~70. Need addi~ional ~-~'PE OF 08Sc~VATION , ;YSICAL EVDENCE ,-. ";" U S E? 6 3 0-329 (T DE) Prevloue a di.tiona ol thla form a:ay ~.. .. .. d. 30. Hove you ever seen this, or a similar object be fore. If ao give dot~ or dat~ rmd location 31. Was anyone else with you at the time you saw the object? (Cird One) 31.1 IF you answered YES, did they see the obiect too? (Circle One) 31.2 Please list their names and addresses: 32. Please give the following information about yourself: Firat Ne~me Middle Name City Zone State TELEPHONE NUMB Indicate any additional information about yourself, including any special experience, whic:h might be pertinent. H~o GENERAL tEI'J~.t F\No BiO'-o6Y tl\) S<..~HocL. !-lAve- TAl:. E ru H t= L ~o PrE R 33. When and to whom did you report that you hod ~een the object? W~\:N V-J<S f1K~\Ut-D 34. Date you completed this questionnaire: -jc> 35. Information which you feel pertinent and which is not adequately covered in the spectfic points of the questionnaire or a narrative explanation of your sighting. RIJit\.Y TO Dl:saA,.TM.NT 0,. TH~ AIR trOitCE HKADQUA .. TI"I I'OIItiiON TICHNO\.OQY OIVIIION fA PIC t WlltiOHTftATTI .. 80N AIR I'ORC:& .A81. OHIO .CS.C3a UFO Observation Reference your unidentified obaervation. 'lhe information vhich we have received is not sufficient for a scientific evaluation. Request you complete the attached F'TD 164 e.nd return 1 t in the envelope provided. Thank you tor reporting your observation to the Air Force. JAMES c. MANATT Director of Technology and Subsystems FTD Form 164 v/envelope TDF:r/tJFO CI: TMINT 0~ TH!: AIR fJ'O"CE HIAOQUA .. TRI I'OJIIION TECHNOL-OGY OIVI.ION l A 'S~) WRIOHT~ATTiftiON AU' f'OftC& 8Aaa. OHIO eJI UFO Observation Reference your un1dent1tiecl obaervation. '!he information which ve have received is not suft1cient.tor a scientific evaluation. Request you complete the attached F~D 164 and return 1t in the envelope provided. Thank you for reporting your observation to the Air Force. S C. MANA 'I'!' Colonel, USAF irector of Technology and SUbaystema FTD Form 164 v/envelope U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has ~en prepared so that you can give the U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you hove observed. Please try to answer os many questions as you possibly can. The information that you give will be used for research purposes. Your name wi II not be used in connection with any statements, ccnclusions, or publications without your permission. We request this personal i,formotion so that if it is deemed necessary, we may contact you for further details. 1. 'Nhen did you see the object? 3. T ii'T'e Zone: Month Year c. ountatn d ... Poe ific 4. Wh ere were you when you sow the object? (Circle One): (Circle On e): (aJ Daylight Saving b. Standard State or County 5. MOW long was obiect in sight? (Total Duration) a. Certain @ Fairly certain 5.1 How was time in sight determined? _...._ 5.2 Was object in sight continuously? 6. What was the condition of the sky? c. Not very sure d. Just a guess Minutes Seconds 7. IF you sow the object during DAYLIGHT, where was the SUN located as you looked at the obiect? (Circle One): a. In front of you b. In back of you c. To your rig,t d. To your left ~ ',4 e. Overhead f. Don't remember H. IF you sow the obiect at NIGHT, what d icf you not tee concerning the ~TARS llnd MOON? 8.1 S T AR5 (C irc/e One}: 8.2 MOON (Circle One): Bright moonlight Dull moon I ight No moonlight -pitch dark d. Don't remember Don't remember 9. What were the weather conditions at the time you sow the object? CLOUDS (Circle One): NEATHER (Circle One): a. Clear sky b. Hazy b. Fog, mist, or light rain c. Scattered clouds (!) Th ~ck or heavy c loud(l'u,.. c. i~oderate or heavy rain e. Don't remember 10. The object appeared: (Circle One): b. Transparent ~ As a light e. Don't remember 11. Jf it appeared as a light, was it brighter than the brightest stars? (Circle One): {iJ Brighter c. About the some b. Dimmer d. Don't know 11.1 Compare brightness to some comm object 12. The edges of the object were: (Circle One): a. Fuzzy or blu:-red b. Like a bri~ht star Shar!"ly out I ined Don't remember 13. Did the object: a. Appear to stand sti II at any time? b. Sl;lddenly speed up and rush away at any time? c. Break up into parts or explode? d. Give off smoke? e, Change brightness? f. Ch-Jnge shape? g. F lash or fJ icker? h. Disappear Clld reappear? (Circle One for each question) Don't know Don't know Don't know Don't know Don't know Don't know Don't know Don't know 14. Did the obiect disappear while you were watehing it? If so how? 15. Did the object move b-.hind som'tthing at any time, porticularly a cloud? (Circle One): 16. Did the obiec:t move in front of something at any time, particularly a cloud? (Circle One): Don't Know. IF you answered YES, then tell what 17. T ftl I in a few words the following things about the object: a. Sound-~ We wish to know the angular sixe. Hold a match stick at arm's length in line with a known object and note how the obiec:t is covered by the head of the match. If you had performed this exJ)eriment at the time of the sighting, how much of the obiect would hove been covered by the match head? 19. Draw a picture that will show the shape of the obiect or objects. Label and include in your sketch any detoi Is of the obiect that you saw such os wings, protrusions, etc., and espec iolly exhaust troi Is or vapor troi Is. Place an arrow beside the drawing to show the direction the obiect was moving 20. Do you think you can stirnate the speed of the objttct? (Circle One) Yes IF yau answered YES, then what speed would you tutimate? --------- 21. Do you think you can timate how far away from you the ......., (Circ:le One) IF you answered YES, ihen how for away would you say it was?-------~- 22. Where were you located when you saw the obiect? (C irele One): 23. W11ra you (Circle One) a. Inside a building (!}In a car c. Outdocws d. In an airplane ('YP4t) o. In rh., business section of a cit1? b. !n the residential section of o city? @ In open countryside? d. Near on oirfi,ld? ~ e. Flying ov~r o city? f. Flying ove:-o~n cov..-,tr'/? 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the folfowing questions:- 24.1 Vt'hat direction were you moving? (Circ:le One) a. Norlh c. East e. South b. Northeast d. Southeast f. Southwest 24.2 How fest were you moving? ---------lmi les per hour. 24.3 Did yOAJ stop at any time while you were looking at the object? (Circle One) Did you observe the ohject through any of ff,e following? Eyeglasses Binoculars b. Sun glasses Windshield Theodolite d. Window gloss h . Northwest 26. In order that you can give as clear o pietvre os possible of what you sow, describe in your own words o common object or objects which, when ploeed up in the sky, wou!d 1he sam'!t apP'!oronce os the object which you saw Ada~ lA dH 27. In the following a\ceteh, imagine that you ortt at the point shown. Place on ''A" on the curved I ine to show how high the obiect was above the horizon (skyline) when you first sow it. Place a "B,. on the same curv~d lin~ to show how high the object was above the horizon (skyline) when you last saw it. Place an "A" on the compass when yQu first sow it. Place a "B" on the compass where you lost sow the obiect 28. Oraw a picture that will show the motion that the object or objects mode. Place an "A" at the ginning of the 29. IF there was MORE THAN ONE object, then how many were there? ----------- Draw a picture of how they were arranged, an~ put an arrow to show the direction that they were traveling. 30. Have you ever s een ~h,:s, oro itmi l.:~r , b jact b,,af\)r!'l. If . ~ ]ivu :.kJ~.J -c.r d.:~ .. H <:ud lccQti~ . 31. Was anyone else wiTh you at th time y ou s ow tho CJbjlct? (Cird~ On~) 31.1 IF you_anawerd YES, di d t htey s..,d th~ obj,.ct too? ( Ci rei <J On-a) 31.2 Please lilt their names and addre.sses: 32. Please give the following infOf'mation a bout yoursel/: F ir~t N ame Middle Name TELEPHONE NUMBER---------- Indicate any additional inf.,rmat ion obour yours~ If, includi ng <My speci :1 ~ t:~p::r i~;tnca, wh ie h rni ght be pertin'!n. 33. When and t o whom d id y ou report thct yc1, had :; n rh.:~ ooj ~ct? TD-er/tJFO DEPARTMENT OF TH :AUt FORCE HEAOQUAIItT~IItS f'OIIt!IGN TI:CHNOLOQY OIVIIIOI'f f A,!tC) WRIGHT P~'r.~ft50N A I , ,O;:tCZ !1..\.JJ:. OHIO _.,.3.1 UFO Observatior1 3 Mar 67 Reference y,,ur unidentitied observation. The information vhich we have received is not sufficient for a scientific evaluation. Request you complete the attached FTD Form 164 and return it in the envelope provided. Thank you for reporting your observation to the Air Force. 3 C. MANATT, Colonel, USAF of Technology and Subsystems FTD Form 164 w/envelope 35. lnfcwmation which you feel pertinent and which is not adequately covered in tne IJMCific points of the questionnaire or a narrative explanation of your sighting. 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 possible concerning the unidentified aerial phenomenon that you have observed. Please try to answer as many questions as you possibly con. The information that you give will be used for research purposes. Your name will not be used in connection with any statements, conclusions, or publications without your permission. We request this personal information so that if it is deemed necessary, we may contact you for further detoi Is. 1. When did you see the object? 3. Time Zone: (Circle One): @ tcstern b. Central c. Mountain d. Pacific 4. Where were you when you saw the object? Nearest Postal Address 5. how long was obiect in sight? (Total Duration) 5.2 Was object in sight continuously? 6. What was the condition of the sky? (Circle One): (C;rcle One): ) Daylight Savi ng b. Standard City or Town State or County Minutes Seconds c. Not very sure d. Just a guess 7. IF you sow the object during DAYLIGHT, where was the SUN located as you looked at the object? (Circle One): a. In front of you b. In back of you ,. c. To your right d. To your left e. Overhead f. Don't remember FTD nrT "' 11-..d ti. IF you sow the obiect ot NIGHT, what d irl you notice concerning the ~ T AJ<S o nd MOON? 8.1 S T AR5 (C irc/e One): d. Don't remember 8.2 MOON ( C ~rcle One): o. Bright moonlight b. Dull moonlight No moonlight -p itch dark D~n 't remember 9. What were the weather conditions at the time you sow the object? CLOUDS (Circle One): HEATHER (Circle One): a. Clegr sky Fog, mist, or I ight rain Scattered clouds c. .\Aoderate or heavy rain d. Thick or heavy clouds e Don't remember 10. The object appeared: (Circle One): (cD As a I ight T ron spa rent e. Don't remember 11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): 0 Brighter c. About the some d. Don't know Compare brightness to some common object: 12. The edges of the object were: (Circle One): a. Fuzzy or blurred b. Like o bri~ht star Did the object: @ Sharply outlined d. Don't remember Appear to stand sti II at any time? b. Suddenly speed up and rush awoy at any time? c Break up into parts or explode? Give off smoke'! Change brightness? Change shape? Flash or flicker? Disappear and reappear? (Circle One for each qu'!:stion) Don't know Don't know Don't know Don't know Don't know Don'' know Don't know Don't know 14. Di~ the obiect disODP40f while you were watching it'? If ~o, how? Did t~ obiftct nt'I'U tim'!, pm'tieu l~rly o e lotd~ / ?/ (Circle One): IF you answered YES, then tell whot 16. Did the obittc:t movl9 in front of $Omething ot any ti,tt, pa.rtieul~rfy o clot.Jd? (C ire le One): on't Know. IF you answered YES, then tell whot 17. T ftll in a f~w words the following things about the object: 18. We wish to know tnl!t an~ulor size. Hold o match stick at orm's lenqth in l ine with a known obittet and note how much of the object is covered bv the hedd of the match. If you hod oerformed this elfo.riment at tne tirM of the sighting, how mucn of the ob!ect would hove been covered by the match head? J/ c1. /c/f ft~ _c~t.d lh 19. Draw a picture that wi II show the shape of the