302539482.pdf

|  1. DATE - TIME GROUP | 2. LOCATION  |
| --- | --- |
|  4 July 65 04/0680Z | Columbus, Ohio  |
|  3. SOURCE | 10. CONCLUSION  |
|  Civilian | INSUFFICIENT DATA FOR EVALUATION  |
|  4. NUMBER OF OBJECTS | Evaluation will be made if form is returned at a future date.  |
|  Not Reported |   |
|  5. LENGTH OF OBSERVATION | 11. BRIEF SUMMARY AND ANALYSIS  |
|  Not Reported | Report received that witness had made an observation of an Unidentified Flying Object. Name, Address, and Phone number of witness only information received. Form 164 sent on 12 July. Not received or returned from witness.  |
…

{04063.2 4JULY 1965
Columbus, 1941

# 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 can. 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 …

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8. IF you saw the object at NIGHT, what did you notice concerning the STARS and MOON?

8.1 STARS (Circle One):
a. None
b. A few
c. Many
d. Don't remember

8.2 MOON (Circle One):
a. Bright moonlight
b. Dull moonlight
c. No moonlight – pitch dark
d. Don't remember

9. What were the weather conditions at the time you saw the object?

CLOUDS (Circle One):
a. Clear sky
b. Hazy
c. Scattered clouds
d. Thick or heavy clouds

WEATHER (Circle One):
a. Dry
b. Fog, mist, or light rain
c. Moderate or heavy rain
d. Snow
e. Don't remember

10. The object appeared: (Circle One):
a. Solid
b. Transparen…

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14. Did the object disappear while you were watching it? If so, how?
?

15. Did the object move behind something at any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, then tell what it moved behind: _______________

16. Did the object move in front of something at any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, then tell what in front of: _______________

17. Tell in a few words the following things about the object:
a. Sound _______________
b. Color _______________

18. We wish to know the angular size. Hold a ma…

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20. Do you think you can estimate the speed of the object?
(Circle One) Yes No
IF you answered YES, then what speed would you estimate?

21. Do you think you can estimate how far away from you the object was?
(Circle One) Yes No
IF you answered YES, then how far away would you say it was?

22. Where were you located when you saw the object? (Circle One):
a. Inside a building
b. In a car
c. Outdoors
d. In an airplane (type)
e. At sea
f. Other

23. Were you (Circle One)
a. In the business section of a city?
b. In the residential section of a city?
c. In open countryside?
d. Near an airfi…

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27. In the following sketch, imagine that you are at the point shown. Place an "A" on the curved line to show how high the object was above the horizon (skyline) when you first saw it. Place a "B" on the same curved line to show how high the object was above the horizon (skyline) when you last saw it. Place an "A" on the compass when you first saw it. Place a "B" on the compass where you last saw the object.

![img-0.jpeg](img-0.jpeg)

![img-1.jpeg](img-1.jpeg)

28. Draw a picture that will show the motion that the object or objects made. Place an "A" at the beginning of the path, a "B…

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30. Have you ever seen this, or a similar object before. If so give date or dates and location.
?

31. Was anyone else with you at the time you saw the object? (Circle One) Yes No
31.1 IF you answered YES, did they see the object too? (Circle One) Yes No
31.2 Please list their names and addresses:
?

32. Please give the following information about yourself:
NAME
Last Name First Name Middle Name
ADDRESS
City State
State
TELEPHONE NUMBER AGE SEX X
Indicate any additional information about yourself, including any special experience, which might be pertinent.

33. When and to whom did you …

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|  MEMO ROUTING SLIP | Never Use for Approvals, Disapprovals, Concurrences, or Similar Actions | ACTION  |
| --- | --- | --- |
|  1 TO HQ USAF SAFOICC (MRS HUNT) | INITIALS | CIRCULATE  |
|   | DATE | COORDINATION  |
|  2 |  | FILE  |
|   |  | INFORMATION  |
|  3 |  | NOTE AND RETURN  |
|   |  | PER CONVERSATION  |
|  4 |  | SEE ME  |
|   |  | SIGNATURE  |
|  REMARKS Request your office send an FTD Form 164 to ~~~~[redacted]~~ Columbus, Ohio, regarding his unidentified flying object observation on 4 Jul 65/~~  |   |   |
|  FROM FTD (TDEW/UFO) | DATE | 12 Jul 65  |
|   | PRIORITY | 6921…