302546595.pdf

|  1. DATE - TIME GROUP | 2. LOCATION | 3. SOURCE | 4. NUMBER OF OBJECTS | 5. LENGTH OF OBSERVATION | 6. TYPE OF OBSERVATION | 7. COURSE | 8. PHOTOS | 9. PHYSICAL EVIDENCE  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  Jan. 66 0220Z | Poulsbo, Washington | Civilian | N/A | 8-10 Minutes | Ground Visual | To the South | To the South | To the South  |
|  10. CONCLUSION | Insufficient Data for | Atty. Archives Branch | McCwell A/B. Alcoormond | 2 | Return to | Not at all | Not at all | Not at all  |
|  11. BRIEF SUMMARY AND ANALYSIS | Observer not sure of data and how many objects t…

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 details.

|  1. When did you see the o…

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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? It went up & up. Must have been nearly again as high as a jet back. We can't was there. Left my view going nearly straight south.

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 wor…

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20. Do you think you can estimate the speed of the object? not for sure but when it leveled off it made that jet
(Circle One) Yes No
I'd last going north look like a Slo mo.
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? The thing was close down when I first saw it and came in to get glasses but I can't tell you first how high
(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…

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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.
No but I saw been looking

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:
M
Powtshoolwash

32. Please give the following information about yourself:

|  NAME | Last Name | First Name | Middle Name  |
| --- | --- | --- | --- |
|  |   |   |   |
|  ADDRESS | Street | City | Zone | State  |
| --- | --- | --- | --- | --- |
|  |   |   | …

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34. Date you completed this questionnaire:
Day 5 Month November Year 1966

35. Information which you feel pertinent and which is not adequately covered in the specific points of the questionnaire or a narrative explanation of your sighting.

I think that State or Q RM lasted of 6, 7, or 8 seconds at about 6:08 or 6:10 A.M. I'm not exactly sure. It was clear cut.

No lights blinked or nothing and there was not a cloud in the sky nor later when I drove up to work at Pt. Gamble that Sat., morning.

I'm only sorry I can't tell you what Sat. it was but it was nice clear as a bell.

As I sta…