23857158-010-049

90 © 2 9.= O58 005 ®) oPamnmoQuUD Maan amo aw z ae sede Mo Boas eS On Sp - ISuaL “SINOCULARS : NONE ST PHONE Ge CEILING UNE TEED NONE..2 7 CER ym NONE “NONE” NONE.

Declassification Authority NND 923007 U. S. AIR FORCE TECHNICAL INFORMATION SHEET This questionnaire has been prepared so that you cam 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 wili be used for research purposes, and will be regarded as confidential material. 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 …

Declassification Authority NND 923007 Poge 2 8. IF you saw the object at NIGHT, TWILIGHT, or DAWN, whet did you notice concerning the STARS and MOON? 8.1 STARS (Circle One): 8.2 MOON (Circle One): o. None a. Bright moonlight b. A few b. Dull moonlight c. Many _.  @s No'moonlight — pitch dark d. Don’t remember . . de Don't remember 9. Was the object brighter than the background of the sky? (Circle One): L ves’) b. No ¢. Don’t remember 10. IF it was BRIGHTER THAN the sky bockground, wos the brightness like that of an automobile headlight?: (Circle One) a. A mile or more away (a distant car)? . b…

Declassification Authority NND 923007 “OY ; Drow o picture that will show the shape of the object or objects. Label ae tre lude in your. ‘sketchy any y detaile a Qeeste of jhe object thet you saw such as wings, protrusions, stc., and especially exhaust, trolls ¢ or "vapor trails Ploce:,. ‘on atrow. boside the drawing to show the direction the: object was moving. : - 18, Tha edges of the object were: (Circle One): a. Fuzzy or blurred e, Other b, r + Sharply outlined — d, Don’t remember -_ ee 19, IF there was MORE THAN ONE object, then how mony were there? — Draw a picture of how they ware arran…

Declassification Authority NND 923007 — pe Page 4 20, 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” ‘at the end of the path, and show any changes in direction during the course. . 2i. iF POSSIBLE, try to guess or estimate what the real size of the object was in its longest dimension. > feet. 22. How large did the object or objects appear as compared with one of the following objects held in the hand and at about orm’s length? (Circle One): a. Head of a pin g. Silver dollar h. Basaball d. Nickel . j. Basketball — ¢. Qu…

Declassification Authority NND 923007 Page 5 25. Where were you located when you saw the object? 26. Were you (Circle One) '. (Circle One): a. In the business section of a city? b. In the re idential section of a city? % teld? a. Inside a building b. Ina car €. Outdoors ; irplone ; e. Flyin over a city? | 6 At sea | 3 §, Blylag over open country? H A Other g- Other 28. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 28.1 What direction were you moving? (Circle One) a. North c. East e- South g- West . b. Northeast d. Southeast f. Southwes…

Declassification Authority NND 923007 Poge 6 32. In the following sketch, imagine that you ore at the point shown. Place an “A” ' ’ 5 an “A” on the curved line + _ high the object was above the horizon (skyline) when you firs? saw it, Place o "B" on ies oietceine show how high the object was above the horizon (skyline) when you Jost saw it. ° 33. In the following larger sketch place an “A” at the position the object was when you first saw it, and-a “B” at its position when you las? saw it. Refer to smaller sketch as an example of how to complete the lorger sketch.

Declassification Authority NND 923007 Page 7 34. Whot were the weather conditions at the time you sow the object? 34,1 CLOUDS (Circle One) 34.2 WIND a One) + Hazy b. Slight breeze ¢. Scattered clouds : c. Strong wind d. Thick or heavy clouds d. Don't remomber e. Don’t remember 34.3 WEATHER (Circle One) 34.4 TEMPERATURE (Circle One) ; . a. Cold b. Fog, mist, or light rain b. Cool c. Moderate orheavy rain > d. Snow d. Hot e. Don’t remember e. Don’t remember 35. When did you report to some official that you had seen the object? Q) ee ; dae sf La3 ie . ay . Mont eor 36. Was anyone else with you at…