PROJECT BLUE BOOK

PACJECT TOO73 RECORD
DATE·TIME GROUP 2. LOCATION
20067 3.00467 ..11500Z 115002 walbe Walber
3. 3. OARCE 10. CONCLUSION 10. CONCLUSION
C.vilian C.vilian Probable (AIHCRAFT) Probable (AIRCRAFT)
V 4 NUJMBER OF OBJECTS NIUMBER OF OBJECTS
The witness thought it was an airplane. The witness t thought it was an airplane.
One
S S. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS 11. BRIEF SUMMARY AND ANALYSIS
10-15 Seconds Observer sighted an object that looked like a Napoleon shaped
6. TYPE OF OBSERVATION hat turned sideways.
Ground-Visual
: COURSE
NE tO E
8. PHOTOS
. Yes
XXNo
IDENCE
Yes
XX No
FORM /
FTD SEP 63 0-329 (TDE) Prevlous editions of this form may be used.
.
T
.
. .

U.S. AIR FORCE TECHNICAL INFORMATION
This questionnair has been prepared so that you can give tho U.S. Air Force as much
information as poss oncerning the unidentified aerial phenomonon that you have observed.
Please try iny questions as you possibly can. The information that you give will
be used for research rposes. 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.
:
.When did you see the object? 1. When did you see the object? Time of day: 10 10 00
Hour Minutes
3 11 11 67 (Circle One): (Circle One): A.M.
or P.M.
Day Month Year Year
. Time Zone: 3. Time Zone:
(Circle One): o. Eastern (Circle One): a. Daylight Saving
b. Central b. Standard
c. Mountain
d. Pacific
e. Other
$In} he ou?
CEnTRAL STATE ChVESiTy wilberfonce GrcenCounTy O110
Nearest Postal Address R7.42 City or Town State or Coonty
5. How long was object in sight? (Tota! Duration) AfROX15. Seconds
Hours Minutes Seconds
a. Certain c. Not very sure
Fairly certain d.
nrted tired noted Turled
5.2 Was object in sight continuously? Yes . 5.2 Was object in sight continuously? Yes No. No
arrired in my h anrivtd in my
6. What was the condition of the sky? What was the condition of the sky?
DAY NIGHT
a. Bright Bright a. Bright
O. Cloudy .Cloudy b. Cloudy b. Cloudy
7.IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object?
(Circle One): a. In front of you d. To your left
b. In bock of you e. Overhead
To your righp f. Don't remember
IBelirve
FORM
FTD OCT 62 164 Thls form supersedes FTn 164, Jul 61, which is obsolete.

/
P*ogn7
8. IF you saw the object at NIGHT, what did you notice concerning the STARS ond MOON?
8.1 STARS (Circle One): 8.2 MOON (Circle One): 7
a. None a. Bright moonlight
b. A few b. Dull moonlight
c. Many No moonlight - pitch dark
d. Don't remember d.Don't remember
9. What were the weather conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER (Circle One):
o. Clear sky .Clear sky a. Dry a. Dry
b. Hazy b. Fog, mist, or light roin /
c. Scattered clouds c. Scattered clouds c. Moderate or heavy rain
d. Thick or heavy clouds d. Snow d. Snow
. e. e. Don't remember
10. The object appeared: (Circle One): 0. The object appeared: (Circle One):
a. Solia d.As a light
Trahsparent Don't remember
c. Vapor
.If it appeared as a light, was it brighter than the brightest stars? (Circle One):
. Brighter c. About the same
b. Dimmer d. Don't know
11.1 Compere brightness to some common object:
12.The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright stor
Sharaly outlined
d. Don't remember d. Don't remember
.Did the object: (Circle One for each question)
a. Appear to stond still at any time? es e No Don't know
b. b. Suddenly speed up and rush away at any time? No Don't know
c. Break up into parts or explode? es CNS Don't know
d. Give off smoke? Give off smoke? Yes Yes N NO Don't know
e. Change brightness? Yes No No Don't know Don't know
f. Change shape? Change shape? Yes Yes No Don'tknow Don'tknow
g. Flash or flicker? Yes 29 Don't know
h. Disappear and reappear? Yes Don't know

.
15. Did the abinct move bahind somathing at any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, then tell what
it moved behind: _
uds were pear.
1.Did the obiect meve in front of something at any time, narticularly a cloud?
(Circle One): Yes C Don't Know. IF you answered YES, then tell what
in front of:
17. Tall in a few words the following things about the obiect:
Eppriny.
1. Draw a picture that will show the shape of the object or objects. Label and includa in your sketch any details
of the objeet that you saw such as wings, protrusions, etc., and espacially exhaust trails or vapor trails.
Place an arrow beside the drawing to show the direction the object was moving. Place an arrow beside the drawing to show the direction the object was moving.
X
turnes
P -
so- orpijes onpipes
D
000
LANE nycne
HALL
PABNF1
1A1

Page 4
2Do you think you can estimate the spoad of the objact?
(Circle One) Y No
2Do you think you can estimate how far away from you the object was?
(Circle One) Yos No
2Where were you located when you saw the object? 23. Were you (Circle One)
(Circle One):
a. In the business section of a city?
a. Inside a building b. In the residential section of a city?
b. In a car c. In open countryside?.he-
c. Outdoors d. Near an airfield? the Counlnpeds
d. In an airplane (type) e. Flying over a city?
e. At sea f. Flying over opon country?
No
25. Did you observe the object through any of the following?
a. Eyegiasses Yes e. Binoculars Yes
b. Sun glasses Yes ②2 f. Telescope Yes
c. Windshieid Yos g. Theodolite Yes
d. Window glass Yes No h. Other
In ordar that you can give as clear a picture as possible of what you saw, describe in your own words a common
object or objacts which, when placed up in the sky, would give the same appe arance as the object which you saw.
Mt

ill ,
Page 5
. In the following sketch, imagine that you are at the point shown. Place ar "A" on the curved line to show how
high the object was above the horizon (skyline) whan you first saw it. Place a k"B" on the same curved line to
show how high the object was above the horizon (skyline) when you lost saw it. Place an "A" on the compass
when you first saw it. Place a "B" on the compass where you las! saw the object.
90°
A 6
43 NW
-15° 15 SW
Draw a picture that will show the motion that the object or objects made. Place an A at the beginning of the
path, a "g" at the end of the path, and show any changes in direction during the course.
B
SA digeh diaspe l dode.
Draw a picrure of how they were arranged, and put an arrow to show the direction that they ware traveling.
14

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Page 6
date or digs end location.
never ifuw
3. Was anyone slse with you at the time you saw the object? (Circle One) Yos No
31.1 IF you answered YES, did they ses the object too? (Circle One) Yos7 No
31.2 Please list thoir names and addresses: these
rearlg,mot
3No
32. Please give the following information about yourself:
tollige odilies s Centra/Sle
celalpversily,sivefore/riy
When and to whom did you report that you had sean the object? When and to whom did you report that you had sean the object? Reponted sighlins To insTuc/ons ReponTed sighlin 7
3 11 nT hee
Day Month Year SuggesTin,
!
8

dject.
air. Isteered
Sheither rakiralil
Mou xn
-
Cnt.

MEMO FOR THE RECORD 3 November 1967
Subject: UFO Sighting, 3 November 1967
alled regarding her unidentified flying object ob-
servation:
Central State University
UFO report:
time: 10:00 AM 3 November 1967 time: 10:00 AM 3 November 1967
place: Over entrance to Central place: Over entrance to Central State University State University
Duration: 10-15 seconds
Object: looked like a Napoleonic hat turned sideways
Flight Characteristics: At first hovering lew away
Altitude: 600 or 700 feet
Sound: None
ing one admitted they didn't know what object Observer
Electrieity & Magetic Electrieity effects: effects: Witnesses car stopped. Witnesses car stopped.

DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREICN TECHNOLOGY DIVISION (AFSC)
WRIGHT PATTERSON AIR FORCE BASE. OHIO 45433
REPLY TO ATTN OF: TDPT (UFO)
NERN93
SUBJECT: UFO Observation , November 3, 1967
TO:
Kenia, Ohio 45385
8482867.
Your name has been given to the Aerial Phenomena Office (Project
Blue Bookas being a witness to an unidentified flying object.
1967
in the envelope provided. If in the envelope provided. If you were not a witness to this
sighting, would you please make a statement to this effect on the
attached form. The information which you provide will be used in attached form. The information which you provide will be used in
evaluating this observation. Thank you for your assistance in this evaluating this observation. Thank you for your assistance in this
matter.
C
KECTOR QUINTANILLA, Jr, MajOr, USAF 1 Atch
/Chier, Aerial henomena Office AF Form 117 w/envelope
Aerospace Technologies Division
Production Directorate
.
-

Keval i 1t) A
AFR 80-17(C1)
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE BUDGET BURSAU APPROVAL
NUMBER 21-R253
THIS QUESTIONNAIRE HAS BEEN PREPARED SO THAT YOU CAN GIVE THE U.S. AIR FORCE AS MUCH INFORMATION
AS POSSIBLE CONCERNING THE UNIDENTIFIED PHENOMENON THAT YOU PLEASE TRY TO
RESEARCH PURPOSES
YOUR NAME WILL NOT BE D IN CONNECTION WITH ANY OF YOUR STATEMENTS OR CONCLUSIONS WITHOUT
PATTERSON AFB, OHIO 4S433, TAW AFR BO-F7. (IF ADDITIONAL SHEETS ARE NEEDED FOR NARRATIVE OR SKETCHES
ATTACH SECURELY TO THIS FORM OR ANNOTATE WITH YOUR NAME FOR IDENTIFICATION.)
1. WHEN DID YOU SEE THE PHENOMENON?
DAY... 3 MONTH 1/ YEAR_ 67
2. WHAT TIM : DID YOU FIRST SIGHT THE PHENOMENON?
HOUR1/:30 MINUTES5 P.M.
3 WHAT TIME DID YOU LAST SIGHT THE PHENOMENON? 3. WHAT E DID YOU LAST SIGHT THE PHENOMENON?
HOUR11,35 MINUTES. MINUTES. 3 C A.M. A.M. P.M.
4. TIME/ZONE DAYLIGHT SAVINGS DAYLIGHT SAVINCS STANDARD
EASTERN CENTRAL MOUNTAIN MOUNTAIN []PACIFIC COTHER
5. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? IF IN CITY. GIVE THE NEAREST STREET ADDRESS AND INDICATE ON
A HAND DRAWN MAP WHERE YOU WERE STANDING WITH REFERENCE TO THE ADDRESS. IF IN THE COUNTRY, IDENTIFY THE A HAND CRAWN MAP WHERE YOU WERE STANDING WITH REFERENCE TO THE AUDRESS. IF IN THE COUNTRY, IDENTIFY THE
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK.
-
1
- is
thlo
6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH. CE AN A' ON THE CURVED LINE TO SHOW HOW HIGH THE
PHENOMENON WAS ABOVE THE HORIZON, OR SKYLINE. WHEN FIRST SEEN. PLACE A B^ ON THE SAME CURVED LINE TO
SHOW HOW HIGH ABOVE THE HORIZON THE PHENOMENON WAS WHEN LAST SEEN.
90 157
1
|
1
1
1 1
1 - 15
| |
OBSERVER OBSERVER If
1
AF FORM 117
AUG 67

MEMO FOR THE RECORD
@23 Mar 68
Called of Xenia Ohio
The line was busy.
Called enia , Ohio
wasn't there but I talked to his wife. She said that he
had told her about had told her about the the incident and thought it was an airpland.
|
14

,'
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BASE. OHIO 45433
REPLY TO TDPT (UFO)
ATTN OF:
JAN 25 1968
SUBJECT: UFO Obse ervation 3 November 1967
TO:
Xenia, Ohio 45385
4665605
Your r Your name has name has been given to the Aerial Phenomena Office been given to the Aerial Phenomena Office (Project
Blue I Blue F Book) as being a witness to an unidentified flying object. Book) as being a witness to an unidentified flying object.
If you were a witness to an UFo sighting on 3 November 1967 If you were a a witness to an UFo sighting on 3 November l967
would you please complete the attached AF Form ll7 and return it
in the envelope provided. If provided. If you were not a witness to this
sighting, would; sighting, would you please make a statement to this effect on the
attached form. The information which you provide will be used in
evaluating this observation. Thank you for your assistance in this observation. Thank you fo your assistance in this
matter.
KECTOR QUINTANILLA, Jr, MajOr, USAF 1 Atch
Chief, Aerial Phenomena Office AF Form 117 w/envelope
Aercspace Technologies Division
Production Directorate
.
141

3tsl7
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BASE. OHIO 4S433
PRPLY TO TDPT/UFO
ATTN OP:
SUBJECT: UFO ervation, 3 November 1967
TO:
Xenia, Ohio 45385
Your name has been given to the Aerial Phenomena Branch Your name has been given to the Aerial Phenomena Branch (Project
Blue Book) as being a witness to an unidentified flying object.
If you were a witness to an UFo sighting on
would you please complete the attached AF Form ll7 and return it
in the envelope provided. If you were not a witness to If you were not a witness tc this sighting,
would you please make a statement to this effect on the attached form.
The information which you provide will be used in evaluating this
observation. Thank you for your sssistance in this matter. observation. Thank you for your assistance in this matter.
MES C. MANATT, COlOne1, USAF 1 Atch
rector oduction AF Form 117
2tie17 6jii
A

-
5 Do067
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT.PATTERSON AIR FORCE BA3E. OHIO 4S433
REPLY TO ATTN OF: TDPT/UFO
oo 1 107
SUaJICT: UFO Cbservation, 3 Wovember 1967
TO:
Xenia, Oh1o 45385
Your I Your name has been given to the Aerial Phenomena Branch (Project name has been given to the Aerial Phenomena Branch (Project
Blue Book) as being a witness to an unidentified flying object. Blue Book) as being a witness to an unidentified flying object.
If you were a witness to an UFo sighting on 3 November 1967 If you were a witness to an UFO sighting on 3 November 1967
would you please complete the attached AF Form ll7 and return it would you please complete the attached AF Form ll7 and return it
in the envelope provided. If you were not a witness to this sighting,
would you please make a statement to this effect on the attached form.
The information which you provide will be used in evaluating this
observation. Thank you for your assistance in this matter. observation. Thank you for your assistance in this matter.
MES C. MANATT, Colonel, USAF 1 Atch
Director o Production AF Form 117
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M

1
37067
TDB/UrO 1
NOV 71967
UPO Obse vation, 3 November 1967
Central State University
10 45384
Reference your unidentified observation. The information which
we have received is not sufficient for a scientific investigation. investigation.
Request you complete the attached FTD Ferm 1 Request you coomplete the attached FTD Ferm 164 and return it in the
envelope provided. previded. Thank you for ting your observation to the obse vation to the
Air Force, Air Force,
AMES C. AMES C. MANATT, Calonel, USAP MANATT, Calonel, USAF 1 Atch
Drector Mrector ogy and Subsystems FTD Form 164 w/envelope
Sod tho 2 lirtrea Snd tho 2 it
listren 117"

/
AFR 80-I7(C1)
BA. NOW INAGINE YOU ARE AT THE CENTER OP THE COMPASS ROSE. FLACE AN A* OM TME COMPASS TO INDICATE THE
DIRECTION TO THE PHEHOMENON WHEN FIRST SEEN. PLACE A *D• ON THE COMPASB TO INDICATE THE DIRECTION TO TME PHENOMENON WHEN LAST SEEN.
NNW NNE
NW NE
WNW ENE
WSW ESE SE
SW SE SE
sSW SSE
7. IN THE SKETCH BELOW, PLACE AN A" AT THE POSITION OF THE PHENOMENON WHEN FIRST SEEN. AND A B* AT THE
POSITION OF THE PHENOMENON WHEN LAST SEEN. CONNECT THE A* AND B° WITH A LINE TO APPROXIMATE THE
MOVEMENT OF THE PHENOMENON BETWEEN *A* AND "B*. THAT IS, SCHEMATICALLY SHOW WHETHER THE MOVEMENT
APPEARED TO SE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW TO COMPLETE THELARGER SXETCH.
(
PAGE2OF9 PACR

i
AFR 80-17(C1)
8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (ChECK APPTOPPINIC blOCKS.)
OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING IN RESIDENTIAL SECTION OF CITY
IN CAR AS DRIVER AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR R AIRFIELD
IN AIRPLANE AS PILOT AS PASSENGER FLYING OVER CITY
OTHER FLYING OVER OPEN COUNTRY
OTHER
A. IF YOU WERE IN A VEHICLE. COMPLETE THE FOLLOWING:
WHAT DIRECTION WERE YOU MOVING? HOW FAST WERE YOU MOVING?
NORTH EAST
SOUTH WEST DID YOU STOP ANYTIME WHILE OBSERVING THE
PHENOMENON?
NORTHEAST SOUTHEAST
NORTHHEST SOUTHWEST YES ]YES NO NO
EXPLAIN WHETHER SUCH MOVEMENT AFFECTS WHETHER SUCH MOVEMENT AFFECTS YOUR SKETCHES IN ITEMS 5 AND 6. YOUR SKETCHES IN ITEMS 5 AND 6.
DESCRIBE TYPE OF VEHICLE YOU WERE IN AND TYPE OF ROAD TERRAIN OR BODY OF WATER YOU TRAVERSED DURING DESCRIBE TYPE OF VEHICLE YOU WERE IN AND TYPE OF ROAD. TERRAIN OR BODY OF WATER YOU TRAVERSED DURING
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW MUCH OTHER TRAFFIC WAS THERE? TRAFFIC WAS THERE?
DID YOU NOTICE ANY AIRPLANES? 7 YES NO. IF YES." DESCRIBE WHEN THEY WERE IN SIGHT RELATIVE TO THE TIME
OF SIGHTING THE PHENOMENON AND WHERE THEY WERE IN THE SKY RELATIVE TO THE POSITION OF THE PHENOMENON.
9. HOW LONG WAS THE PHENOMENON IN SIGHT?
LENGTH OF TIME CERTAIN OF TIME NOT VERY SURE
FAIRLY CERTAIN JUST A GUESS
HOW HAS TIME DETERMINED?
WAS THE PHENCMENON IN SIGHT CONTINUOUSLY? C YES NO. IF NO.° INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INOICATE DISAP.
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

AFR &0-17(C1)
1O. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WERE
ARRANGED. DID THIS ARRANGEMENT CHANGE DUIRING THE SIGHTING?
K
11. ConDiTiONs(Check appropriate blocks.)
A. SKY B. WEATHER
DAY CUMULUS CLOUDS (LOW fluffy) FOG OR MIST
TWILIGHT CinRus CLoups (ligh fleecy or Herring HEAVY RAIN
NIGHT NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR CLEAR NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
COMPLETELY OVERCAST COMPLETELY OVERCAST (Thunderstorms) UNKNOWN
HAZE OR SMOG NONE OF THE ABOVE
C.IF THE SIGHTING WAS AT TWILIGHT OR NIGHT. WHAT DID YOU NOTICE ABOUT THE STARS AND MOON?
(1) STARS (2) MOON
NONE BRIGHT MOONLIGHT NO MOONLIGHT
A FEW MOON WITH HALO UNKNOWN
MANY MOON HIOOEN BY CLOUDS
UNKNOWN PARTIAL(New Or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? YES I NC. IF YES,WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (NeW nOOR)
IN BACK OF YOU TO YOUR LEFT UNKNOWN
E. SPECIFY THE MAJOR SOURCE OF ILLUMINATION PRESENT DURING THE SIGHTING, SUCH AS THE SUN, HEADLIGHTS OR
STREET LAMP, ETC. FOR TERRESTRIAL ILLUMINATION, SPECIFY DISTANCE TO LIGHT SOURCE.
12. GIVE A BRIEF DESCRIPTION OF THE PHENOMENON, INDICATING WHETHER IT APPEARED DARK OR LIGHT, WHETHER IT
REFLECTED LIGHT OR WAS SELF-LUMINOUS ANO WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER
IT WAS SOLIO OR TPANSPARENT, WHETHER EDGES WERE SHARP OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT
APPEARED AS A POINT OF LIGHT. INDICATE COMPARISONS WITH OTHER OASERVED OBJECTS, LIKE STARS, A LIGHT OR
OTHER OBJECT IN YOUR FIELD OF VIEW.
PAGE 4 OF 9 PAGES
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DISAPPEAR AND REAPPEAR?
SPIN LIKE A TOP? SPIN LIKE A TOP?
MAKE ANGISE? MAKEANGISE"
FLUTTER OR WOBBLE? FLUTTEROR WOBBLE?
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON?
A. HOW DID IT FINALLY DISAPPEAR?
B. DID THE
YES C NO. IF *YES,"DESCRIBE.
PAGESOFIP•
11

AFR 80-17(C1) -
IS. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT
HAVE APPEAREO AS WINGS OR PROTRUSIONS, AND INDICATE E.XHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
a
16. WHAT WAS THE AYGULAR SIZE? HOLD A MATCH AT ARM'S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET
LAMP OR THE MOCN. NOTE HOW MUCH OF THE OSJECT IS COVERED BY THE HEAD OF THE MATCH. NOW IF YOU HAD
BEEN ABLE TO PERFORM THIS EXPERIMENT AT THE TIME OF THE SIGHTING, ESTIMATE WHAT FRACTION OF THE
PHENOMENON WOULD HAVE BEEN COVERED BY THE MATCH HEAD.
PAGE 6 OF 9 PAGES

i
AFR 80-17(C1)
17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INGLUDE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLABSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE .
WINDONPANE OTHER
A. DO YOU CRDINARILY WEAR GLASSES? YES CINO B. DO YOU USE READING GLASSES? YES 0NO
1B. WHAT WAS YOUR IMPRESSION OF THE SPEED OF THE 19. WHAT WAS YOUR IMPRESSION OF THE DISTANCE OF THE
PHENOMENON? GIVE ESTIMATE OF SPEED PHENOMENON' GIVE ESTIMATE OF DISTANCE
2O. IN ORDER THAT WE MAY OBTAIN AS CLEAR A PICTURE AS POSSIBLE OF WHAT YOU SAW, DESCRIBE IN YOUR OWN WORDS
A COMMON OBJECT OR OBJECTS WHICH, WHEN PLACED IN THE SKY, SIMILAR TO WHERE YOU NOTED THE PHENOMENON,
WOULD BEAR SOME RESEMBLANCE TO WHAT YOU SAW. DESCRIBE SIMILARITIES AND DIFFERENCES BETWEEN THE
COMMON OBJECT AND WHAT YOU SAW.
/
(
21. DID YOU NOTICE ANY ODOR, NOISE, OR HEAT EMANATING FROM THE PHENOMENON OR ANY EFFECT ON YOURSELF.
ANIMALS OR MACHINERY IN THE VICINITY? YES ]NO. IF YESDESCRIBE.
A. DID THE PHENOMENON DISTURB THE GROUND OR LEAVE ANY PHYSICAL EVIDENCE. C]YES ClYES NO.
IF *YES," DESCRIBE. IF"YES,"DESCRIBE.
PAGE 7OF 9 PAGES
141

AFR 80-17(C1)
2. HAVE YOU EVER SEEN THIS OR A SIMILAR PHENOMENON BZFONE? VES NO. IF *YES, GIVE DATE AND
LOCATION.
23. WAS ANYONE WITH YOU AT THE TIME YOU SAW THE PHENOMENON! NO. IF YES. DID THEY SEE IT TOO?
YES NO.
A. LIST THEIR NAMES AND ADDRESSES
24. GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME. FIRST NAME, MIDDLE NAME LAST NAME, FIRST NAME, MIDDLE NAME
ADDREss (Street, City, State and Zip Code)
TELEPHONE(Area code and number) TELEPHONE(Area cOde and number) AGE
MALE FEMALE
INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCZ WHICH MAY BE PERTINENT. INEORMATION INCLUDIHG OCCUPATION ANO EXPERIENCE WHICH MAYBE PERTINENT
.
25. WHEN 25. WHEN AND TO WHOM DID YOU REPORT YOU REPORT THAT THAT YOU HAD SIGHTED THIS PHENOMENON?
NAME DAY. MONTH YEAR
26. DATE YOU COMPLETED THIS QUESTIONNAIRE.
DAY. MONTH YEAR
PAGE 8 OF 9 PAGES