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OA iE '. TIMe GROUP

17 Jun 67 17/05302 - - -3. :i i)u r:n:

Civil i:m --1. NLII!8ER OF OBJECTS

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1 .... LENGTH OF OBSERVATION

30 m:inutes r.. 1"1'PE OF OBSERVATION

Ground Visual

17. COURSE

North -(l, Ptf OTOS

I n Yes :X No

19. PHYSICAL EVIDENC E

n Yo~ X No

FORM

PROJEC1" 10073 RECORD ----------- .-.. - ·--..1 = 2. LOCA TION

Xenia, O~io 10. CONCLUSION

lllSUF'FICIEi\T DA' Y\ FOR EVALUATION

11. BRIEF SUMMARY AND ANALYSIS

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Observer stated Brightness of t:' ObJect ~ppearcd were :ruzzy end · Color: not rep

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tct the object appeared to be a light. le object was compared to th~t of a star. t o be brighter than the sta:- . Edges of the

>lurred. The object had a r roring sound. >rted

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f= TD S E P 6 3 0-329 (TOE) Pre•lou e e d ition • of lhh l orm ""'' ,. u .. d.

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IUI'L. Y TO ATTN 0,

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OIE,.ARTMENT OF THE AIR FO~CE

TDET/UFO

UFO Observation

XUJ.1.:I.o. ,

Reference y(>ur unidentifi ed observat1.on. The information which we have r eceived is not sufficient for a scientific evaluation. Request you complete the attached FTD Form 164 and return 1t 1n the envelope provided . Thank you for reporting your observation to the Air Force .

S C. MANATI' 1 Colonel , USAF rector of Technology und Subsystems

1 Atch F?D Form 164 v/envelope

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U.S. AIR FORCE TECHNICAL INFO RMATION

This questi onnai re has been prepared so that you con give the U.S. Ai r Force as much informat ion as possible concern ing the unidentified aerial phenomenon that you hove observed. Please try to answer as many questions as you possibly con . The informat ion that you give w ill

be used for research purposes. Your name w ill not be used in connecti on with any statements,

conclus ions, or publications without your permission. We request this personal informat ion so

t hat if i t is deemed necessary, we may contact you for further detai ls.

-.:"":-:.::.:a.-- - --=---~.:. .. -· -- ·- ;=:.:----:;:..---::-.=- - - ':'-::::-:::~-----·--~----=- ": ::.:. l ":

1. When did you see the object?

[2 JV~ 07 Day Month - Yoor

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3. Time Zone: --(Circle Onc):r a-:_. t:astern b. Central

c . Mountain d . Pacific e. Othe r

4. Wh.,re were you wh"n you sow the ob jec t ?

i t " _____ _._l~t._~0 11 -'l- • - -·-·-

• Neore:tt Postal Address

3o 2. Tir,,e of day: _ 0 0 ._ -------· Hour Minutes

(Circle One): P.M.

(Circle One):Q Day l ight Saving b. St andard

Le/'y'- ~tt~ -- -- -{J(LQ

--··· C ity or T ow n Stoto or County

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5. hOW long wos ohjttct in sighr? (Totol Durcr.on ) •...J

Hours Minutes Soconds

a. C.Htoin c . Not very sure

b. Fat(ly certa in d. Just a guess

5.1 How w::o ~ ime m s igh t determined? ________ \.v~'-; -A~...~I__::(_=-.:..H..:.· _______ _

5.2 Was objec t in sigh t c ontinuous ly?

6 . W:1ut . .,.,; thlol conditi'Jn o f th'! 3'<y?

DAY a. Bright b. Cloudy

Yes ----

NIGHT o Bright

c:£:claudy

No __

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7. IF you sow the object du r ing DAYLIGH T , where was the SUN located as you looked ot the object ?

(Crrcl<! Om,): IJ. In front of you b. In bock of you c. To your r ight

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e . Ov.::h~od f. Don 't remember

• FORM

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FTD OCT 62 164 I ) 'Jo r:--1. .~~ /'1 ~ -c;r .,)50 ~! .... : _1'_,_~ .;_,.;,

Thla l orm aupetudea FTT> 164, j u l 6 1, which Ia Ob!lol.t.. ..;t../ ., . ._ .;.~ ·Y-• ;·:: ' iO ( '..:.!..)'?<.)' ~

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8. IF you saw the objec t at NIGHT, what did you notice concern ing the STARS ond MOON?

8.1 STARS(CircleOne):

GJ None b. A few c. Many d. Don 't remember

8.2 MOON (Circle One):

a . Bright moon light b. Dull moonligh t a No moonligh t - pi tch dark d. Don ' t reme mber

9. What were the weathe r condi t ions a t the ti me you saw the object ?

CLOUDS (Circle One):

a. Clea r sky

b. Hazy

c . Scatte red c louds

@Thick or heavy clouds

WEATHER (Circle One):

r:2Dry '---('Fog, mist, or light ra in

c. Moderate or heavy rain

d. Snow e . Don ' t remember

10. The object appeared : (Circle One):

a . Solid b. T ronsporent

(_I) As a I igh t c. Don 't re member

c. Vapor

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J 11. If it appeared a s o light, was it brigh ter t han the br ightest stars? (Circle One):

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ASrighfe r

"----'6. D i tn mer

c. Abou t the some

d . Don ' t know

Compa re brigh t_ness to some common ~jec(tr.f / } /J t

,!~ ,-.,\ ,r.. , , F ;'/ l/ '\.J1 \ • A ~ I ' / : .... l! ~ ___ ___ ...;.•_.ffi t~ · , '.1'-' v 7 .;._,...·_ ...d...t-J-~':=...~,_-l,._Nf""-"---+~-T;---=-"-· _ ...... ..;;;.=.1(../- ---------------J "

The edges a t the oilj .,ct were: , .......

(C irc!e One);/ a ,/ Fuzzy or blurred '-b. Like o br iyh t s tar

e. Other -----------------

c. Sharp ly out lined • ___________________ ...;.._ __________ __

d. Don ' t remember

Did the object : (Circle One for each ques t ion) -

Appear ro stand still a T cny tirne? /. No Don't know o. %-~-/ b. Sudden ly speed up and rush away a t any time? cr.:0 No Don ' t know @) c . Break up into ports or explode? Yes ~~L.kn.ow ·--..... d. Give off smoke? Yes No ILLk~~

e . Change br igh tness? Yes No cgon 'tkn~w _) f. Change shape? Yes ~No ) on 't 'l<now

9· Flc-;h or fli cker? Ye.s~ ! •. Do., ' t know ( ]'/.0--6;;Y. h. D i ·; .; ;::>;_Jao~ and r.:app.:ar? 1 0 Don ' t know

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14. Did the object disappetor whi le you were watching it? H so, how?

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15. Did the object move behind something at any time, part icularly a cloud?

(Circle One): Yes @ it moved behind: ---------------------------------------·

Don't Know. IF you answered YES, then tell what

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16. Did the objec t move in front of something at any t ime, particularly a cloud?

(Circle One): / Yes )

in front of: 5:._ .. 2 ......,-----------------· 7F L. r=:: .s . . J) n<.cc T L y

Don' t Know. IF you a ns wered YES, then te ll wha t No ·- - --- ------- - - ·- ---- .

:CG i \ S·ro R~ -- -----~~~---------4 OVGlc

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18.

Te ll in a few words the follow ing things about the object :

.Rt,t\ \~ I rJ G- - L I k..'E"" .1\ l R a . Sound --'--· _ C oN Dt Tl o N £:1(: ---~----~--------------1 -

b. Co lor ..... ~.~---------------------------------------------------------------1

We wi sh to know the angu lar s ize. t-lo ld o match s tick at arm's length in line with o known object and note how

much of the object is covered by the head of the match . If you hod performed th is experiment ot the t ime of the

sight ing, how much of the object wou ld hove been covered by the ma tch head?

i<.' . I ;--, V'\ . - 1'- L "'

19. Draw a p1c ture that writ show the shape of the object or objects. Lobel and include in your sketch any details

of the objec t ~hot you sow such as wings, protrusions, etc., end espec ially exhaust trails or vapor tra ils.

Place en arrow bes ide the drawing to show the direction the object was moving.

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20. Do you thi nk you con estimate the speed of the object?

(Circle One} Yes G~

IF you answered YES, then what speed would you estimate? -------

21. Do you think you con estimate how for away from you the obj e c t was?

(~J No · ·--

IF you answered YES, then how for away would you soy it was? __ o_-_,(_'-'-'/_L.:_-__ h_-_:;;>_L () [ k (Ci rcle One}

22. Where were you located when you sow the objec t?

(Circle One): 23. Were you (Ci rcle One)

a. In the business sec tion of a city?

Pog& 4

(~)In t he residentia l section of a city? a. Inside a building

b. In a cor c . In open countrys ide?

d. Near on airfield?

e. flying over a c ity?

G"; butdoors

d. In on airplane (type)

e. At sea f. Flyi ng over open country?

f. Other --------------- g. Other ---------------

24. IF you we re MOV ING IN AN AUTOMOB ILE or other vehicle a t the t ime, then complete the following questions :

• 24.1 What direc tion were you moving? {Circle One)

o, North c. Eo:o;t e. South g. West

b. Northeo~t d. Southeast f. Southwes t h. Northwe s t

24.2 How f o::s~ were you moving? --------J m",i les per hour.

24.3 Dtd you s top CJt any t ime while you w"'" looking a t the object?

(Cir .:fe Om: ) Y~s No

1 2s. D id you observe !hi! objec t th rough any of d-e fo llowin g?

( o. Ey t'gbsse~ Ye s No e. Binocu lars Yes @ b. Sun glo s s es Yes No f. Telescope Yes No

Windshield Theodolite Yes No I .

c. Yes No g. •

d. Window gloss Yes No h. Other

26. In ord.:r tt, o t you c on give as c l:.w r o pic1 1Jre as possible of what you sow, d o;crib.:: in your o'Yn words a common

objec t or objec ts which, wh en placed up in the sky , would give the some a ppearance as the object whi ch y ou sow •

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27. In the fo ll owing sketch, imagine that you are a t the point shown. Place on " A" on the curved l in~ to show how

h igh the object was above the horizon (skyline} when you first saw it. Place a "B" on the some curved l ine to

show how high the object was above the horizon (s kyline} when you last sow it. Place on "A" on the compass

when you fi rs t sow it.

goo Place a "B" on the compass where y ou las t sow the object . ~-?

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28. l.lrow a picture that wi ll show the motion that the object or objec ts mode. Place on "A" at the begi nning of the

path, o "13" ot the end of the path, and show any changes in direction during the course •

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29. If tnere wa s ''-'ORE THAt~ ONE object, rhen how many were tl,ere ? -----Drew Q picture 0! now they were arranged, an.:l put on arrow to Sn,')W the di rect ion that they were trave l ing.

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30. Hove you ever seen this, or o similar object before. If s o give dote or dotes and location •

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31. Was anyone el se with you a t the time you sow the obj e ct ? (Circle One) Yes

31.1 IF you answered YES, did they see the object too? (Circle One) Yes No

31.2 Ple ase list their names and addresses:

oNL Y,

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32. Ple ase give the f lowing informat ion about yourself:

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F irst Nome I •

_R..;_'-+) _...c..&~~ C ity

ADDRESS --~~~.A .. _O __ State Zone

.. _ -TE LEPHONE NUMBER ----- --- AGE ___ _ SEX

1nd icat~ any etddi t ionol inforMation about yourself, includ ing any special experience, wh ich might be pertinent.

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33. When and to whom did you report that you had seen the object?

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34. Date you completed th is questionnaire: - ~ ~ Doy Year

- . - ------------·---- -- --·----- ___ .,. ____ _ 35. Informat ion which you feel pertinent and which is nat adequately covered in the specific points of the

questi onnaire or a narrative explanation of your s ighting.

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