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NATIONAL INVESTIGATIONS COMMITTEE AERTAL PHENOMENA
announces tho appointmont, as of 2 January, 1964,
of
MR. MICHAEL RICHARD FREEDM
as the sole representative of its Youth Council
for tho Commonwoalth of Ponnsylvania.
All corrcspondencs relative to Unidontificd Acrial

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Ob jocts (U 4.0.8) nay bo forverdod by mA nil
iir. Froodmen at tho following addross:

2237 Strohlo Stroct

Philadolphia, Pennsylvania, 19152

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This questionnaire has been prepared so that you can give the U.S. Air Force 35 much

information cs possible concerning the unidentified aerial phenomenon that you have observed.
Pisose try to answer a5 many en as You possibly ¢ can. The information thet you give wi!

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be used for research purposes. Your nome will not be used in connection with « Ay sictarnents,

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conclusions, or publications without your permission. We request this personel informetion so

that if it is deemed nacassury, we may contact you for further details,

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1. When did you see the object?

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| 4, Wheres were you when you sow the object? ;
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i 5, How long was object in sight? (Total Quration) tt) = het a? Ss :
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a. Certain Cc. Not very sure
| OG) Fairly certain d. Just a guess
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5.1 How wos time in sight datermined? COMARIPISON (LUUTH SSOP NTI CR
| 5.2 Was obiact in sight continuously? Yes X_. < | een
| 6. hot was the condition of the sky?
| DAY NIGHT
(2) Bright a, Bright
D. Cloudy b, Cloudy
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| 7. \F you saw the object during DAYLIGHT, where wos the SUN located as you lor
(Circle Ona): a. ta front of you 4, Yo your teft
&. In back of you 2. Overhecd
,) To your ric gnt f, Don Pr yememoar

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FORM
“10D OCT 62 i64 This form supersettes F TD 154, ful ol, »

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15. Did tha object nove Lahind so nating af any time, particvlas a LY

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' 6. Did the obieet move in front of comething af sny time, perticulanly « cloud’ ;
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17, fart in a tew words the following things about the cuject;
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; De visa TO KNOW thea ONnguiar size, ioiad @ matcn sticx a? arm §s nes In the 1a known © Se kb fo. ds YoY
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19, Orow a picture that will show the shape of the object or obiects. Label! und include in your scatch any catatts |
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of the object that you saw such ¢s wings, protrusions, etc., and especially exhaust trails or vapor iretis. ,

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Place on arrow >2side the drawing to show the direction the object was moving.

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+ 2. Do you think you can estimate the speed of the object?
(Circle Qne) (Yas > No
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IF you enswered YES, then what speed would you estimate? 7°" fi
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| 21. Do you think you can estimate how far away from you the objact was’
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| (Cirela One) Yes) No

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iP you onswered YES, then now far away would you say ii was? _7.. 47¢4 ee
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. Where were you locoted when you saw tha object? | 33. Were you (Uircie One,
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a. Jn the business section of a city?

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inside G oulliding 5b, In ine residential section of @ clive

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24. IF you were MOVING IN AN AUTOMOSILE or other vehicle at the tims, thea compleie the following questions;
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; 24.1 What direction wera you moving? (Circle One) }
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Gc. Nortn ¢. test 2. South o. West '
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24,2 How fast were you moving? . __..._—.mii@s per hour.

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24.3 Did you stop at any time while you wears looking at the object?

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(Circle One) Yes No

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| 25. Did you observe the object through any of the following? ;
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a. Eyeglasses L¥23s> No e. Binoculars Yes ‘Ro
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b. Sun giasses Yes CNo/ f, Telescope Yes ‘Ne
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| c. Windshie'd Yos (No) g. Theodolite Ye Ko
d. Window gicss Yes ‘No OR RE EE ee ae eee tana
| 26. in order that you can give as clear c picture as possible of what you sow, cescrioe in your o- ws 2 a
| sb} act or objects which, when ploced up in the sky, would give ihe seme cppearonce us tha shject b vou
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34. Date you completed this questionnaire: ln LO urd 1 i> ook

| | Day Month Yeor

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information which you feel pertinent and which is not adequately covered in the specific points of the |

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questionnaire or co norrativea explanation of your sighting.

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