:tr;rlTATIVE ,.-. _ _,--r-h~ Do f'. ... OBSERVERS OUESTI ONNAmE (/ V EQ. T ION A fJ ':.I) 1. Hhe n did you sea the object: Honth Ye~r 1.2 Time of day: A.H. or P.H. (Circle One} Hrs. 1-Iin. 1 .3 Timg Zone: (Circle One): a, Eastern d. Pnci fic b. Contral c. Nountain (Circle Ona): a . Daylight Saving b . Standnrd 1.4 Q:i:rolt'l ona of the follm-ling to indicate ho1.o~ c ert::lin y ou ar e or your ans,.rer to the abova question 1.2: a. Certain c. Hot vary su.ce b. Fairly certain d. Juot a guess \-There did you see the objoct? Postal Addreso City or Tot~n State Country ,.Jh e n you nat.J the obj ect: Hhere Here 'you located (Circle Ona): a. Inside a building In an airplan3 (Circle One) : n In the bus i nes3 section of In the residential s ection In op9n countryside? Flying near an airfield ? Flyi ug ove r a city? Fly ;ng over opan country? of o city? 4. How did you happen to notice the 5. Whe n did you report to soma official that you had soon the objoot? Day ~1onth Year St:CTIOIT B fl. \rThnt Hore you doing at tha .time you sm~ 'the object? Hhat had you been doing for the JO minutes before you snu object? Try to list the activity or activities, and the approximate mount of time spent on e ach. .. 7. Here you moving at any time \:hilo you sal-J the object? (Circle One): Yes or ITo. \ IF you anawered XY~, the n conplote tr.e follaJ ing quo~tions. 7.1 Hhat direction \I ere y ou moving? (Circle One): a. llorth L. Northeast d. Southeao"\i r. s outh"es t h. lJorth'tJest 7.2 HoH fast \Jere you moving? miles p~r hour. 7.3 Did you atop ct a ny tir.e lihile you Hero lookinc at tho o~joct'? (Circlo One): Yes or ITo 8. Hha t direction \Jera you facine Hhen you f :trs t SU\J tho object? (Circle One) : b, Northeast d. Southeast r. s outh,.Je s t ( g , Hcs t h. N or tht-J est 8.1 l-Ihat directi on t-Jere you facing when the object d:tsnppea r cd? (Circle One): a. North b. NortheaJt f. Southl-sest c. East g. Hest d. Southeast h. N orth'l>J est 8.2 ~rcle .Qlli! of the foll owing to indicata heM certain you are of your anm1ar to the above t\-JO questions . (8 and 8.1) c. Not very sure b. Fairly certain d. Jus t a Lruess 9. Hore you wearing eye elasses when you sau the object? (Circle One): 10. Hot~ \Jas t he object seen? (Circle One): a. Thr ough t-Jindo'J glass b. Through windshiel d e. Through binoculars d. Through telescope e. Through theodolite t. Through o un glasses Through open space 11. Hhat do you remember about the \.leather conditions at the time you saw the object? 11.1 CLOUDS (Circl e One) 11 .3 HEATHER (Circl e One ) Fog, Ni:rt, or light rain Scattered clouds Ncderate or heavy rain Thick or heavy clouds Don't remember Don't remerabet' 11.2 HUT[) (Circle One) 11.4 TENFERATURE (Circle One) Slie;ht bree ze Cool Strong \ i i~d Don' t remember d. o . l)')n t t romer'lbcr 12. E~timate hou long you s aw the objectl _j Soconds 1-rinutes 12.1 Q.irclo gn~ of the following to indicate how cor~ain you are of your nns\ler to Que~tion 12: ~a) Certain ti. Fairly sure o. Not very sure d. Just a guess 13. Did the object look: (Circle One ) Solid or :!:rttn~pq_;r::ent? Did the object at any tima: Change direction? Change speed? Chanee size? Change color? Break up into parts or G i v 9 off smoke? Change brightnesa? Flicker, throb, or Remain motionless? 15. Did the object give off a light? (Circle One for each question) Don't lmc1-1 Don't kno~J Don't k nC\J Don't knct l No Don't knC\>J (~ D~r;i t knoH One): YeS\ No Don't knct..~ 15.1 JF you answered YES uhat l.Jas the color of the light? 16. Tell in n few Yord3 the follO\.Jing thlngs about the object? 16.1 Sound 16.2 Color 17. IF there \oJas NonE THAN Ol'!E object, then ho\.J tnany \Jere there? Dr al-l a picture of how they \-Jere arranged and put an arro\1 to show the direction they Yere traveling. 18. Did t he object at any t:inm: lfl.l Nove b ehind something? (Circle One ) Yes ~lo Don' t l<nm-1 IF you ans"ercd YES , the n t al l 'vJhn t it moved behind 1 8.2 Nova in front of somethine ? (Circle One ) Yes JF you anS\Jered YES, then tell lJhnt it moved in front of. 10 .3 Blend ,.Ji th t he background? (Circle One ) Yes Uo Don' t knc'' Hhich of tho follm.Jing objects object you saw? (Circlo One): is about tho same nctu:1l size as the Automobile g. Srr.:tll airplane Basketball h. Loree airplane D:tcycle ,.,heel Office desk 19.1 2j.rcle one of the follm-Jing to irrlico.t e hc\1 c ertain you are of your anst-1er t o Question 19. a. Certain rb;) Fa~rly cer t ain c. Not very zure d. Uncertain 20. Try t o t ell the follo':ling thines about the object: 20.1 How high above the earth \las it? 20.2 Hou f a r '~as it from you? feet or " . nile9 20 .3 Ho-w fast \Ja s i-G going? _ .. ; f"-miles p e r h our . 20.4 Circle one of the follo~Jing to indicate hc\1 c ertain you are of your ansuer to the abo-ve quentions: a. Certain c. l ! ot very sure b., Fairly c ertain d. Jus t a guc3s 21. Hm~ did the ob ject di~appear from viel1? (Circle One) : a. Suddenly b. Gradually Don' t rerr.ci.tber SECTIO~J D 22. In the following sketoh i maeine your eye nt the point shown. Plnco a n A" on the curved line to sho\~ how high the ob.jcct \-Ja s above t ho horizon you !_i"rst saw it. Plo.ce a "B" to ohou \Jh ere it \-las lthen \.Jhon you J ns t saw it. 2.3. In the following sketch place an "A" at the position t ho object \Jas \lhen you first sa\1 it, and a at ito position Hh e n you l a a t sow it. H 'lri z 'ln Hf)r i z 'ln y..,ur eye Drn\1 a picture tha t will ohot.J the motion thot the object made . an "A" at the beginning of its path and a "B" at the end of its 25 . DraY a picture t ho.t t~:tll ~ho\.1 t ho sh a.pe of the objo ct. Lobel and incll'de in your sket ch any d et ails of the object th:1t you ~m.s, and place o.n urroH b eside the dra\ling to shmJ the direction t h o object vlns moving 26. Hns thls the first time th'lt you h a v e seen an object like this? (Circle One): Yes Ho lF you e.nsHered NO, then 1-1hen, t-~hcre, nnd under uha t conditions did you sea other ones? 27. In your opinion t-Jh:tt do you think the object \Jas a nd \olha t might h a ve caused it? 28 . Give the following information about yourself: Last l1:1me First Nome liiddl e Harne Street City Zone State TELEPIIOHE NUNBER Hhat in your present job? Lnst School Attend ed Year of l ant a ttendance at tr.is school 29. Uus anyone cl::;e uith you ut the tine you sa\J the object? (Circle One ) : Yes 29,1 IT you nns\Jered YES, did they see the object too? (C irole One ) : Yen 29 . 2 Please list thc:tr nameo and addresses: 30. Please add here any further cor:mento \Jhich you believe arc important, Uoe additional sheets of the s ar.o siza paper if nccasonry