PROJECT BLUE BOOK

i
PROJECT 10073 RECORD 71
1. DATETIME GROUP 2. LOCATION
6 November é7 07/00302 Dayton, Chio (2 Witnesse..
3. SOURC. 3. SOURC. 10. CONCLUSION 1. CONCLUSION
1
C1ian Crian INSUFFICIENT DATA INSUFFICIENT DATA
4. NUMBEA OF OBJECTS NUMBEA SF OBJECTS
Cne
5. LENGTM OF OBSERVATION LENGTA OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS
hANd
Not Reported Not Reported Second bak report. Observers were sent a Form 1l7 but falied Observers were sent a Form 1l7 but faiied
6. TYPE OF OBSERVATION T - ORSE VATION to return them.
Ground-Visual
7. COURSE
Not Reported
8. PHOTOS
Yes
XXNO
9. PHYSICAL EVIDENCE
Yes
XXNo
FORM
FTD SEP 63 0-329 (TDE) Previous editions of this forra may be usod.
.
11

6A. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN A* ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A °B° ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMENON WHEN LAST SEEN.
N
NNW NNE
NW NE
WNW ENE
WSW ESE
SW 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 NOVEMENT
APPEARED TO BE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SXETCH AS AN EXAMPLE OF HOW TO COMPLETE
THELARGER SKETCH.
PAGE 2 OF 9 PAGES

V1
8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCk appTOPrlate blocKs.)
OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING IN RESIDENTIAL SECTION N OF GITY
IN CAR AS DRIVER 0 AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR 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 DIPECTION WERE YOU MOVING? HOW FAST WERE YOU MOVING?
NORTH EAST
SOUTH WEST DID YOU STOP ANYTIME WHILE OBSERVING THE
PHENOMENON?
NORTHEAST SOUTHEAST
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS 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
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW HOW MUCH MUCH OTHER OTHER TRAFFIC TRAFFIC WAS THERE? THERE?
DID YOU NOTICE ANY AIRPLANES? YES NO. IF YES, DESCRIBE WHEN THEY WERE IN SIGHT RELATIVE TO THE TIME
OF SIGHTING THE PHENOMENON AND OF SIGHTING THE PHENOMENON AND WHERE REY WERE IN THE SKY RELATIVE TO THE POSITION OF THE PHENOMENON.
9. HOW LONG WAS THE HOW LONG WAS THE PHENOMENON PH IENOMENON IN SIGHT? IN ISIGHT?
LENGTH OF TIME CERTAIN OF TIME NOT VERY SURE
3\f{miNTo4miN. FAIRLY CERTAIN JUST A GUESS
HOW WASTIMS-DETERMINED?
ASP G
WAS THE PHENCMENON IN SIGHT CONTINUOUSLY? YES NO. IF NO,INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

1O. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WER?
ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING?
11. CONDiTioNs (Check appropriate blocks.)
A. SKY B. WEATHER
DAY X CUMULUS CLOUDS (LoW luffy) FOG OR MIST
TWILIGHT CIRRUs CLouDS (High fleecy or Herring- HEAVY RAIN
NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
COMPLETELY OVERCAST (Thunderstorms) UNKNOWN
HAZE OR SMOG NONE OF THE ABOVE
C. !F 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 HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? YES YES,WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (Newr noon)
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.
(SEESRETCH)
J
0
PAGE 4 OF 9 PAGES

THENCCANCE
A. HOW DID IT FINALLY DISAPPEAR?
OBVECT
:n 2
B. DIO THE PHENOMENON MOVE BEHIND OR IN BUILDING AT ANY TIME?
DYESE Y
/
ErECYOoT OF SiciT. .
NoTE: Loc OUERCAsT Is ONCYA PoSSiBiCT
SEE 13
PAGE 5 OF 9 PAGES

15. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT
HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
16. WHAT WAS THE ANGULAR SIZE? HOLD A MATCH AT ARM'S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET
LAMP OR THE MOON. NOTE HOW MUCH OF THE OBJECT 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.
ABOOT AC OF THE OBgEEr WOOLD HOE BeEN
Coverere
PAGE 6 OF 9 PAGES

17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUDE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSNIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDOWPANE OTHER
A. DO YOU ORDINARILY WEAR GLASSES? X NO B. DO YOU USE READING GLASSES7 YES [N0
18. WHAT WAS YOUR IMPRESSION OF THE SPEED OF IHE 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 CCMMON 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 CB.ECT AND WHAT YOU SAW.
OBURCT HADTHE SHAPE OFA SPOOL O IAREAD.
DEFiNTE SPEED CR DiSTANCE
N0TE18419-100
CAN BE AssomED, Ar TimE IT SeEmED To BeTHe
SAME SPERD As A HiCHt FirinG JET. AFTER MoCI -
TE OBJE Whicn IT
50e ET.HicH. MAinCy
DROPED.
21. DID YOU NOTICE ANY ODOR, NOISE, CR HEAT EMANATING FROM THE PHENOMENON OR? ANY EFFECT ON YOURSELF,
ANIMALS OR MACHINERY IN THE VICINITY?
IF *YES," DESCRIBE.
PAGE 7 OF 9 PAGES

-
22. HAVE YOU EVER SEEN THIS OR A SIMILAR PHENOMENON DEFORE? JYES NO. IF *YES," GIVE DATE AND
LOCATION.
23. WAS ANYONE WITH YOU AT THE TIME YOU SAW THE PHENOMENON? YES
YES NO.
A. LIST THEIR NAMES AND ADDRESSES
24 GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME BARST NAME, MIDOLE NAME
ADDRESsS. City, Stateanh. C
TEomoNENArea code and number)
MALE FEMALE
INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT. INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT.
PRESSMAn 2aAssemBCs taAssemBC
10o OTHRE OTHRE ExCEPT THAT MY MOTIER WAS EMPiOYEP
VEMRSFND I H KNow
235.0104
25. WHEN AND TO WHOM DID YOU REPORT THAT YOU HAD SIGHTED THIS PHENOMENON?
DAY.3 MONTH. Noo. YEAR
NAME
26. DATE YOU COMPLETED THIS QUESTIONNAIRE.
DAYG YEAR1567
PAGE 8 OF 9 PAGES

Cloinate at fint repont Dwoid that the eteject
egaing fost 9 was foily high.
The rea
1 9 OF 9 PAGES

23 67
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AII BASE. OHIO 43433
MZPLY TO ATTN OF: TDPT/UFO
NDY301067
BUBJSCT: UTO Observation, 23 November 1967
TO:
Dayton Chfo 45405
Your name has been given to the Aerial Phenomena Branch (Project
Blue I Book) as being a witness to an unidentified flying object.
1967
would you please complete the attached AF Form ll7 and return it
in the envelope provided. If you were not a witness to Ce erveiope Plovia o Cn1s srgireuis, this sighting,
would you please make a statement to this effect on the attached form. 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.
JAMES C. MANATT, COlOnel, USAF 1 Atch
Director Production roduction AF Form 117 AF Form 117

I
BOB Nr 2l-R258
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE
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 HAVE OBSERVED. PLEASE TRY TO
ANSWER ALL OF THE QUESTIONS. HE INFORMATION YOU GIVE WILL BE USED FOR RESEARCH PURPOSES.
YOUR NAME WTLL NOT BE USI WITH ANY OF XOUR STATEMENTS OR CONCLUSIONS WITHOUT
YOUR PERMISSION. RETURN E BASE INVESTIGATOR FOR FORWARDING TO FTD (TDETR), WRIGHT-
PATTERSON AF3, OHIO 45433, IAW 80-17 F ADDITIONAL SHEETS ARE NEEDED FOR NARRATIVE OR SKETCHES
ATTACH SECURELY TO THIS FORM OR AI NOTATE WITH YOUR NAME FOR IDENTIFICATION.)
1. WHEN DID YOU SEE THE PHENOMENON?
DAY23 MONTH 72 YEAR 1967
2. WHAT TIME DID YOU FIRST SIGHT THE PHENOMENON?
HOUR. MINUTESA.M. P.M.
. WHAT TIME DID YOU LAST SIGHT THE PHENOMENON?
C MINUTES5A.M. GP.M.
HOUR
4. TIME/ZONE DAYLIGHT SAVINGS STANDARD
EASTERN CENTRAL MOUNTAIN PACIFIC OTHER
S. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? IF IN CITY, GIVE THE NEAREST STREET ADDRESS AND INOICATE ON
A HAND DRAWN MAP WHERE YOU WERE STANDING WITH REFERENCE TO THE ADDRESS. IF IN THE COUNTRY, IDENTIFY THE
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK.
.-
X X
wh
in powch
5. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE 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
L.
1
1
1
1 30
1
1
1 15
OBSERVER
AF FORM 117
AUG 67

.
670007
Bonding DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT.PATTERSON AIR FORCE BASE. OHIO 4B433
REPLY TO
ATTN OF: TDPT/UFO NOV231S7
SUBJECT: UFO Observation, 6 November 1967
TO:
CARWOO
Reference your recent unidentified flying object sighting which
— you reported to the Air Force. The information which we have
received is not sufficient for a scientific investigation. Request
you complete the attached AF Form ll7 and return it in the self-
addressed envelope. Thank you for reporting your observation to
the Air Force. the Air Force:
MES C. MANATT, Colonel, USAF 1 Atch
Brector oduction AF Form 117

GA. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN A" ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A *B° ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMENON WHEN LAST SEEN.
N
NNW NNE
NW NE
WNW ENE
WSW ESE
sW 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 BE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW TO COMPLETE
THE LARGER SKETCH.
PAGE 2 OF9 PAGES

"
B. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCk appTOPRlate bloCKs.)
OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING √ IN RESIDENTIAL SECTION OF CITY
IN CAR 0 AS DRIVER AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR 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 OIRECTION YOU MOVING? HOW FAST WERE YOU MOVING?
NORTH EAST
SOUTH WEST DID YOU STOP ANYTIME WHILE
PHENOMENON?
NORTHEAST SOUTHEAST
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS 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
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW MUCH OTHER TRAFFIC HOW MUCH OTHER TRAFFIC WAS THERE?
DID YOU NOTICE ANY AIRPLANES? 0 YES NO. IF *YES, DESCRIBE WHEN THEY WERE IN SIGHT RELATIVE TO THE TIME NO. IF *YES," DESCRIBE WHEN THEY WERE IN SIGHT RELATIVE TO THE TIME
OF SIGHTING THE PHENOMENON AND WHEPE THEY WERE IN THE SKY RELATIVE TO THE POSITION OF THE PHENOMENON.
9. 9. HOW LONG HOW LONG WAS THE PHENOMENON IN SIGHT? IN SIGHT?
LENGTH OF TIME CERTAIN OF TIME CERTAIN OF TIME NOT VERY SURE
ahant 5 mut FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMINED?
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY? YES NO. IF "NO," INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
Dt wanld disippian
bilwen elouds it limes
at hin at ceseypeaned
icn fclloo
PAGE 3 OF 9 PAGES

10. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THEREY DRAW A PICTURE TO SHOW HOW THEY WZRE
ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING?
11. CoNDiTiONs (Check appropriate blocks.)
A. SKY B. WEATHER
DAY CUMULUS CLOUDS (LOW fluffy) FOG OR MIST
TWILIGHT CIRRus CLouDs (High fleecy or Herring- HEAVY RAIN
NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
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 HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? YES NO. IF *YES, * WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (Near noon)
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.
I1 cu aany
wa bugitn
then tten timis.
PAGE 4 OF 9 PAGES

DISAPPEAR AMO REAPPEARI
SPIN LIXE A TOP?
MAKE A NOISE?
FLUTTER OR WOBBLE?
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON?
spotted
fufen I vent en M aneles
iin hyen.
A. HOW DID IT A. HOW DID IT FINALLY DISAPPEAR? ISAPPEAR?
afte it wuent ofte it wnt
ye,
yes nosth it wauldt nosth it wauldt
reapree
thin st es gone. It ded nut
wme de 20 i nust houe
rent lufend clouds.
B. DID JHE PHEHOMENON MOVE BEHIND OR IN FRONT OF SOMETHING, LIKE A CLOUD, TREE, OR BUILDING AT ANY TIME?
[CHYES NO. IF YES, DESCRIBE.
and was hididen U hefurid
louds at tne.
PAGE 5 OF 9 PAGES
.

15. 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 EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
itwas ivli
luke di
igit
Aiwe~
16. WHAT WAS THE ANGULAR 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 OBJECT IS COVERED BY THE HEAD OF THE MA  CH. NOW IF YOU HAD
BEEN ABLE TO PERFORM THIS EXPERIMENT AT THE TIME OF THE SIGHTING, ESTIMATE WHAT FRACTION OF THE PHENOMENON NOULD HAVE BEEN COVERED BY THE MATCH HEAD.
It loakid ike
at ry liave bein
an inak in Lengite
ind $\rrac
L
PAGE 6 OF 9 PAGES

.
17. DID YOU O9SERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUOE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDOWPANE OTHER
A. DO YOU OROINARILY WEAR GLASSES? YES NO B. DO YOU USE READING GLASSES? YES M NO
18. WHAT WAS YOUR IMPRESSION OF THE SPEED OF THE 19. WHAT WAS YOUR IMPRESSION OF THE DISTANCE OF THE
GIVE ESTIMATE OF SPEED 100 meh PHENOMENON? ? GIVE ESTIMATE OF DISTANCE
20. IN ORDER THAT WE MAY OBTAIN AS CLEAR A PICTURE AS POSSIBLE OF WHAT YOU SAW, DESCRIBE IN YOUR OWN WORDS
A COMMCN OSJECT 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 CBJECT AND WHAT YOU SAW.
lookd lke
Wil t 1a
bagi
cu dn oval
wew Shig lka
ANIMALS OR MACHINERY IN THE VICINITY? YES LNO. IF YES, DESCRIBE.
YES NO.
IF "YES,"DESCRIBE.
PAGE 7 OF 9 PAGES

1
22. HAVE YOU EVER SEEN THIS OR A SIMILAR PHENOMENON BEFORE? NO. IF YES GIVE DATE AND
LOCATION.
23. WA8 ANYONE WITH YOU AT THE TIME YOU SAW THE PHENOMENON? S YES NO. IF THEY SEE IT TOO?
YES NO.
A. LIST THEIR NAMES AND ADDRESSES
m
24. GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME, FIRST NAM MIDDLE NAME
ADDREs's (Strees, City, Sus-and Zip Code)
Dogton Ohe 454 os
TELEPHONE(Area code and mymber)
14 MALE FEMALE
INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT.
sudent
25. WHEN AND TO WHOM DID YOU REPORT THAT YOU HAD SIGHTED THIS PHENOMENON?
DAY 23 MONTH. 770 -YEAR/17
NAME
25. DATE YOU COMPLETED THIS QUESTIONNAIRE.
DAY_25
PAGE 8 OF 9 PAGES

" .,
27. INFORMATION WHICH YOU FEEL IS PERTINENT BUT WHICH IS NOT ADEQUATELY COVERED IN THIS QUESTIONNAIRE, ALTERNATIVELY PROVIDE A NARRATIVE EXPLANATION OF THE SIGHTING.
whan it went nunih cluop Jhurniny Glou
for x It
1
it
bh mutal
32
PAGE 9 OF 9 PAGES

e1
OD xpot
BOB Nr 21-R258
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE
THIS QUESTIONNAIRE HAS BEEN PREPARED SO THAT YOU CAN GIVE THE U.S. AIR FORCE AS MUCH INFORMATION
AS POSSISLE NING THE UNIDENTIFIED PHENOMENON THAT YOU HAVE OBSERVED. PLEASE TRY TO
ANSWER AI OUESTIONS THE INFORMATION YOU GIVE WILL BE USED FOR RESEARCH PURPOSES
WITH ANY OF YOUR STATEMENTS OR CONCLUSIONS WITHOUT
YOUR PERMISSION. RETURN TO AIR FORCE BASE INVESTIGATOR FOR FORWARDING TO FTD (TDETR), FRIGIIT-
PATTERSON AFB, OHIO 4S433, IAW 80-17. (IF ADDITIONAL SHEETS ARE NEEDED FOR NARRATIVE OR SKETCHES
ATTACH SEOURELY TO THIS FORM OR ANNOTATE WITH YOUR NAME FOR IDENTIFICATION.)
1. WHEN DID YOU SEE THE PHENOMENON?
DAY23. MONTH N02 YENR/967
2. WHAT TIME DID YOU FIRST SIGHT THE PHENOMENON?
HOUR2135 MINUTES A.M. C5..
3. WHAT TIME DIO YOU LAST SIGHT THE PHENOMENON?
HOUR 2139 MINUTES A.M. 4
4. TIME/DONE DAYLIGHT SAVINGS STANDARD
ASTERN CENTRAL MOUNTAIN PACIFIC OTHER
5. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? IF IN CITY, GIVE THE NEAREST STREET AODRESS AND INDICATE ON
A HAND DRAWN MAP WHERE YOU WERE STANDING WITH REFERENCE TO THE AODRESS. IF IN THE COUNTRY, IDENTIFY THE
HIGHWAY YOU WERE ONS MO TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK
N
/ 2
6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE AN *A* ON THE CURVED LINE TO SHOW HOW HIGH THE 6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE AN *A* ON THE CURVED LINE TO SHOW HOW HIGH THS
PHENOMENON WAS ABOVE THE HORIZON, OR SKYLINE, WHEN FIRST SEEN. PLACE A "B° ON THE SAME CURVED LINE TO
SHOW HOW HIGH ASOVE THE HORIZON THE PHENOMENON WAS WHEN LAST SEEN.
SL
1
!
1
1
1
1
1 15
OBSERVER
AF FORM 117
AUG 87

GA. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN *A" ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A *3* ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMENON WHEN LAST SEEN.
N
NNW NNE
NW NE
WNW ENE
/
WSW ESE
SW 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 "O. THAT IS, SCHENATICALLY SHOW WHETHER THE MOVEMENT
APPEARED TO BE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW TO COMPLETE
THE LARGER SKETCH.
PAGE 2 OF 9 PAGE5

61067
OF
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BASE. OHIO 45433
REPLY TO ATTN OF:
TDPT/UFO
NOV 22196
SUBJECT: UFO Observation 6 November 1967
TO:
Calwood, Ohio 45873
Reference your recent unidentified flying object sighting which
you reported to the Air Force. The information which we have
received is not sufficient for a scientific investigation. received is not sufficient for a scientific investigation. Request
you complete the attached AF Form ll7 and return it in the self-
addressed envelope. Thank you for reporting addressed envelope. Thank you for reporting your observation to your observation to
the Air Force. the Air Force.
1 Atch
Birector of Production AF Form 117 .
-

8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCk apprOprlate blocKs.)
OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING IN RESIDENTIAL SECTION OF CITY
IN CAR AS DRIVER C AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR AIRFIELD
IN AIRPLANE 0 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 MOVING?
NOPTH EAST
SOUTH WEST DID YOU STOP ANYTIME WHILE OBSERVING THE
PHENOMENON?
NORTHEAST SOUTHEAST
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS YOUR SKETCHES IN ITEMS AND 6.
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?
DID YOU NOTICE ANY AIRPLANES? YES 0 NO. IF YES, DESCRIBE WHEN THEY WERE IN SIGHT RELATIVE TO THE TIME
OF SIGHTING THE PHENOMENON OF SIGHTING THE PHENOMENON AND WHERE AND WHERE THEY WERE IN THE SKY RELATIVE TO THE POSITION OF THE PHENOMENON. THEY WERE IN THE SKY RELATIVE TO THE POSITION OF THE PHENOMENON.
9. HOW LONG WAS THE PHENOMENON IN SIGHT? HOW LONG WAS THE PHENOMENON IN SIGHT?
LENGTH OF TIME CERTAIN OF TIME NOT VERY SURE
4 min FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMINED? A
e
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY ES NO. IF NO, INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

1O. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WERZ
ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING?
1
11. CONDiTiONs (Check appropriate blocks.)
A. SXY B. WEATHER I
DAY CUMULUS CLOUDS (LOW fluffy) FOG OR MIST
TWILIGHT CIRRus CLouDs (High fleecy or Herring- HEAVY RAIN
NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
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) (2) MOON MOON
NONE BRIGHT MOONLIGHT BRIGHT MOONLIGHT NO MOONLIGHT
A FEW MOON WITH HALO UNKNOWN
MANY MOON HIDDEN BY CLOUDS MOON HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter) PARTIAL (New or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN N VISIBLE? YES NO. IF YES, WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (New noon)
IN BACK OF YOU TO YOUR LEFT 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 AND WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER
IT WAS SOLID OR TRANSPARENT, WHETHER EDGES WERE SHARP OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT
APPEARED AS A POINT OF LIGHT. INDICATE COMPARISONS WITH OTHER OBSERVEO OBJECTS, LIKE STARS, A LIGHT OR
OTHER OBJECT IN YOUR FIELD OF VIEW.
Oblong libe 8r00t thead
d
L
Colod with red eigt meug
tavel.
PAGE 4 OF 9 PAGES

DISAPPEAR AND REAPPEAR?
SPIN LIKE A TOP?
MAKE A NOISE?
FLUTTEROR WOBBLE?
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON?
Movement of olyeit
A. HOW DID IT FINALLY DISAPPEAR?
As As it disAppenief,
B. DID IHE PHENCMENON MOVE BEHIND OR IN F FRONT OF SOMETHING, LIKE A CLOUD, TREE, OR BUILDING AT ANY TIME?
PES NO. IF YES,"DESCRIBE.
Wooued behind thin clouds
siqht at All times until
PAGE 5 OF 9 PAGES

15. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL. ANY DETAILS THAT MIGHT
HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
N
.
.
16. WHAT WAS THE ANGULAR SIZE? HOLO A MATCH AT ARM'S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET
LAMP OR THE MOON. NOTE HOW MUCH OF THE OBJECT 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 VOULD HAVE BEEN COVERED BY THE MATCH HEAD.
mith wonlid have coneed abjest
PAGE S OF 9 PAGES

17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUDE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIRTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDDWPANE OTHER
A. DO YOU ORDINARILY WEAR GLASSES? 0 YES SANO B. DO YOU USE READING GLASSES? YES NO
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 T. 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 CSJECT AND WHAT YOU SAW.
500 8 the
Small
21. DID YOU NOTICE ANY ODOR, NOISE, OR HEAT EMANATING EROM THE PHENOMENON OR ANY EFFECT ON YOURSELF,
ANIMALS OR MACHINERY IN THE VICINITY! CYES NO. IF *YES,DESCRIBE.
A. DID THE PHENOMENON DISTURB THE GROUND OR LEAVE ANY PHYSICAL EVIDENCE. YES LNO.
IF "YES," DESCRIBE.
PAGE 7 OF 9 PAGES

LOCATION.
23. WAS ANYONE WITH YOU AT THE TIME YOU THEY SEE IT TOO?
YES 0 NO.
A. LIST THEIR NAMES AND ADDRESSES
24. GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME, FIRST NAME MIDDLE NAME
2.3
ADDREss (Street, City, State and Zip Code)
hio
TELErHonETArea cod and numbET AGE
20 MALE FEMALE
INDICATE ADOITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT. PERreNcE wmieH mAY oe rerTment.
25. WHEN AND DiD YOU REP THAT YOU HAD SIGHTED THIS PHENOMENON?
NAMESSIA.J.BRO.UN.NG DAY2-3MONTH02 YEAR1467
26. DATE YOU COMPLETED THIS QUESTIONNAIRE.
DAY 2-3 MONTH /02 YEAR1567
PAGE 8 OF 9 PAGES

SE
27. INFORMATION WHICH YOU FEEL IS PERTINENT BUT WHICH IS NOT ADEQUATELY COVERED IN THIS QUESTIONNAIRE, ALTERNATIVELY PROVIDE A NARRATIVE EXPLANATION OF THE SIGHTING.
none.
/
PAGE 9 OF 9 PAGES

Request wind velocity and direction for
Dayton, Ohio 23 November 1967 at 2l00 hrs.
local. Surface, 6,000, 10,000, 16,000, and
20,000.
TDPTUFO
70196

NOV 24 1967
TDPT (UFO) MaJ Quintanilla/70916/mhs/24 Nov 67
URO Observation, 23 November 1967
Mr
Dayton, Ohio 45405
Your name has been given to the Aerial Phenomena Office (Project
Blue Book) as being a witness to an unidentified flying object.
The information we received indicated that you may have also obtained
photographs of O. If you were a witness and did obtain photo-
you please complete the attached photographic data sheet and AF Foru
1l7 and return then with your original negatives. Original negatives
are necessary to perform a scientific investigation. 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 and upon completion of analysis
DO PI B (I) we will return your negatives along with our findings. 5 Thank you for
your assistance in this matter.
EECTOR (UINTANILLA. Jr, Ma,jOr, USAF 2 Atchs

". 23G0'67
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATT AIR FORCE BASE. OHIO 4S433
RIPLY TO TDPT/UFO
ATTN OF: NOV 2410A7
SUBJECT: UFO ervation, 23 November 1967
TO: Mr. & Mrs
cayt Ohio 45406
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 23 November 1967
would you please complete the attached AF Form ll7 and return it J
in the envelope provided. If you were not a witness to this sighting, 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.
MES C. MANATT, COlOnel, USAF 1 Atch
director irector Production roduction AF Form 117

UFO REPORTED: Captain Don Porter, Oakwood Police Bp# Dept.,
called at approx. . 1930 hours 6 Nov 67 to report the
sighting of an unidentified object by to Oakwood boys.
rs old)
Tel
yrs old)
Tel
Capt Porter stated that the boys were very sincere the boys were very sincere
when they described the the following object
CLear Plastic CLear Plastic
Red lights around this
section
Object was circular.
Boys were not contacted. All above info. received from
Capt. #PORTER.
Mf
1)

.
*
2340
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BA5E. OHIO 45433 O
MRPLY TO TDPT/UFO
ATTN OF:
NOV 24 1967
BUBJECT: UFO Observation, 28 November 1967
TO:
Dayton, Ohio 45406
Your name has been given to the Aerial Phenomena I Branch (Project
Blue I Book) as being a witness to an unidentified flying object.
-
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, in the envelope provided 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.
MES C. MANATT, COlOneL, USAF MES C. MANATT, COlOneL, USAF 1 Atch
frector rector of Production roduction AF Form 117
-

237067
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BASE. OHIO 45433
ARPLY TO
ATTN OF: TDPT/UFO NOV 241967
SUBJZCT: UFO Observation, 23 November 1967
TO:
Dayton, Ohio 45406
Reference your recent unidentified flying object sighting which
- you reported to the Air Force. The information which we have
received is not sufficient for a scientific investigation. Request
you complete the attached AF Form ll7 and return it in the self-
addressed envelope. addressed envelope Thank you for reporting your observation to Thank you for reporting your observation to
the Air Force. the Air Force.
AMES C. MANATT, COlOnel, USAF MES C. MANATT, COlOnel, USAF 1 Atch
Arector Arector roduction iction AF Form 117 AF Form 117
-

.
.,
2370067
DEPARTMENT OF THE AIR FORCE
NEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC) WRIGHT.PATTERSON AIR
FORCE BASE. OHIO 4B433
MEPLY TO ATTN OF TDPT/UFO
BUSJICT UFO Observation, 23 November 1967 NON 241957
TO: Mr. & Mrs
Dayton, Ohio 45406
Your name has been given to the Aerial Phenomena Branch
- Blue Book) as being a witness to an unidentified flying (Project
If you object.
would you please complete the attached AF Form ll7 and return it 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. would you please make a statement to this effect on the attached form.
The information which you provide will be used in evaluating The information which you provide will be used in evaluating this this
observation. Thank you for your assistance in this matter.
AMES C. MANATT, COlOnel, USAF 1 Atch
Director of Production Production AF Form 117
-

DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSOI
ARPLY TO ATTN OF: TDPT/UFO
UFO Observation, 23 November 1967 NOV 24 1901
SUBJECT:
TO: Mr. & Mrs.
Dayton, Ohio 45406
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
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.
Duintanillsk
Colchel, USAF 1 Atch
Director of Production AF Form 117
my waw he and he

".. 237067
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATT AIR FORCE BASE. OHIO 45433
REPLY TO BOV 841967
ATTN OF: TDPT/UFO
BURJRCT: UFO Observation, 23 November 1967
TO: or
Dayton, Ohio 45406
Your name has been given to the Aerial Phenomena Branch (Project
- Blue I Book) as being a witness to an unidentified flying gobject.
1967
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, 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 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.
1 Atch
Production AF Form 117

BOB Nr 2l-R258
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE
THIS QUESTIONNAIRE HAS BEEN PREPARED SO THAT YOU CAN GIVE THE U.S. AIR FORCE AS MUCH INFORMATION
AS POSSIGLE CONCERNING THE UNIDENTIFIED PHENOMENON THAT YOU HAVE OBSERVED. PLEASE TRY TO
ANSWER ALL THE QUESTIONS. HE INFORMATION YOU GIVE WILL BE USED FOR RESEARCH PURPOSES.
NECTION WITH ANY OF YOUR STATEMENTS OR CONCLUSIONS WITHOUT
YOUR PERMISSION. RETURN TO AIR FORCE BASE INVESTIGATOR FOR FORWARDING TO FTD (TDETR), WRIGHT.
PATTERSON AFB, OHO 45433, IAW BO-17. (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! Thar 232d
DAY... MONTH Ner:YEAR1947
2. WHAT TIME DID YOU FIRST SIGHT THE PHENOMENON?
Cepprpmatly HOUR_ MINUTES A.M. P.M.
3. WHAT TIME DID YOU LAST SIGHT THE PHENOMENON? 3c
Cpplonmatily HOUR MINUTES A.M. P.M.
4. TIME/ZONE DAYLIGHTISAVINGS STANDARD
EASTERN CENTRAL MOUNTAIN PACIFIC COTHER
5. WHERE WERS 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, IOENTIFY THE
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK.
tn front of thi hiue at Cajtin,
333
--+ -T----
X /
6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE AN "A" ON THE CURVED LINE TO SHOW HOW HIGH THE
PHENOMENON WAS ABOVE THE HORIZON, OR SKYLINE, WMEN FIRST SEEN. PLACE A "B° ON THE SAME CURVED LINE TO
SHOW HOW HIGH ABOVE THE HORIZON THE PHENOMENON WAS WHEN LAST SEEN.
90 1
.
1 A B
1
1
1
1
1
1 15
1
OESERVER
AF FORM 117
AUG 67

GA. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN 'A* ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A *B* ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMENON WHEN LAST SEEN.
-
N
NNW NNE
NW NE
WNW ENE
WSW ESE
SW 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 BE STRAIGHT, CURVEO OR ZIG-ZAG. REFER TO SMALLER SXETCH AS AN EXAMPLE OF HOW TO COMPLETE
THELARGER SKETCH.
PAGE 2 OF 9 PAGES

.
8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCK aPprOPRlaSe bloCKS.)
Lo OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING L IN RESIDENTIAL SECTION OF CITY
IN CAR AS DRIVER AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR 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 CIRECTION WERE YOU MOVING? HOW FAST WERE
NORTH EAST
SOUTH WEST DID YOU STOP ANYTIME WHILE
PHENOMENON?
NORTHEAST SOUTHEAST
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS 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
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW MUCH OTHER TRAFFIC WAS WAS THERE?
DID YOU NOTICE ANY AIRPLANES? YES YES X x 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 THE PHENOMENON IN SIGHT? PH HENOMENON IN SIGHT?
LENGTH OFTIME CERTAIN OF TIME NOT VERY SURE
Cipprofimatly 15 minuites FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMYNED?
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY? M YES NO. IF NO, INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

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 DURING THE SIGHTING?
11. CONDiTiONs (Check appropriate blocks.)
A. SKY B. WEATHER I
DAY CUMULUS CLOUDS (Low fluffy) FOG OR MIST
TWILIGHT CIRRUs CLouDs (High fleecy or Herring- HEAVY RAIN
NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
COMPLETELY OVERCAST (Thunderstorms) UNKNOWN
HAZE OR SMOG L NONE OF THE ABOVE
C. IF THE SIGHTING WAS AT TWILIGHT OR NIGHT, WHAT DID YOU NO TICE ABOUT THE STARS AND MOON?
(1) STARS (2) MOON MOON
NONE BRIGHT MOONLIGHT NO MOONLIGHT
A FEW A FEW MOON WITH HALO UNKNOWN
MANY MOON HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter)
D. IF SISHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? 0 YES NO. IF YES, WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (NeW noon)
IN BACK OF YOU TO YOUR LEFT UNKNOWN UNKNOWN
E. SPECIFY THE MAJOR SOURCE OF ILLUMINATION PRESENT DURING THE SIGHTING, SUCH AS THE SUN, HEADLIGHTS OR E.S 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.
Stut Lamp Xtut
12. GIVE A SRIEF DESCRIPTION OF THE PHENOMENON, INDICATING WHETHER IT APPEARED DARK OR LIGHT, WHETHER IT
REFLECTED LIGHT OR WAS SELF-LUMINOUS AND WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER
IT WAS SOLID OR TRANSPARENT, WHETHER EDGES WERE SHARP OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT
APPEARED AS A POINT OF LIGHT. INDICATE COMPARISONS WITH OTHER OBSERVED OBJECTS, LIKE STARS, A LIGHT OR
OTHER OBJECT IN YOUR FIELD OF VIEW.
thee wae a wiry bright white light which seimed to
Unaili to
dicirn any
4ae.
PAGE 4 OF 9 PAGES

FLASH OR FLICKERI F
DISAPPEAR AND REAPPEAR? X
SPIN LIKE A TOP?
MAKE A NOISE?
FLUTTEROR WOBBLE?
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON?
Certther pirson
A. HOW DID IT FINALLY DISAPPEAR?
einpneiin einbneuin
1
B. DIO THE PHENOMENON MOVE BEHIND OR IN FRONT OF SOMETHING, LIKE A CLOUD, TREE, OR BUILDING AT ANY TIME?
YES X NO. IF *YES,"DESCRIBE.
Nut that ceull ece, at liast.
PAGE 5 OF 9 PAGES

1
PROJECT 10C7S RECORD
DATE-TME CROLP 2. LOCATION
25 Noverrer 24/02152 sayton, Chio (Multipl
SOTIR 10. CONCLUSION
Civa.l Very Probable (HOT AIR BALLOON)
4. NUMEL  OF OBJECTS At 2100 hrs the wind was blowing from l9o deg or ap rc.  :
about 4 knots. This is consistent with the rlight a.  e e
One by some observers. The description is just like theé. i.
5. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS Air Da-.oons
.
4 to -5 Minutes Observers sighted a bright luminous object that was weser.bed as Objec. una.
5. TYPE OF OBSERVATION TYPE OF OB ATION by scme as circular and by scme circular and some as some like a spool of thread. e a spool of thread. The, The
object traveled roughly object traveled roughly NW. One said the lignt "arpeared to NW said the lignt "arpeared to
Ground-Visual be carried by a bailoon be carried bailoon or parachute". Before it disaprcare. or parachute". Before it disappcare.
7. COURSE it appeared to ürop several firey pieces toward tne earth.
The observation was made by two independent groups. oindependent groups.
SA tc E SA tc L
8. PHOTOS
Yes 0 Yes
XOXNO XXNO
9. 9. PHYSICAL EVIDENCE PHYSICAL EVIDENCE
n Yes
XOXNO
FORM
FTD SEP 63 0-329 (TDE) Prevlous editions of thle form mey be used.
.

15. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT
HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
tinksoin, dui :to drrkniaa.
16. WHAT WAS THE ANGULAR SIZET HOLD A MATCH AT ARM'S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET
LAMP OR THE MOON. NOTE HOW MUCH OF THE OBJECT 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.
tlnknoun,s -C
/
PAGE 6 OF 9 PAGES

17. DID YOU O3SERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INGLUDE INFORMATION ON NODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDOWPANE QTHER
A. DO YOU ORDINARILY WEAR GLASSES? M NO B. DO YOU USE READING GLASSES? YES NO
18. WHAT WAS YOUR IMPRESSION OF THE SPEED OF THE 7 19. WHAT WAS YOUR IMPRESSION OF THE DISTANCE OF'THE
PHENOMENCN? 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 COMMCN O3JECT OR OBJECTS WHICH, WHEN PLACED IN THE SKY, SIMILAR TO WHERE YOU NOTEO THE PHENOMENON,
WOULD BEAR SOME RESEMSLANCE TO WHAT YOU SAW. DESCRIBE SIMILARITIES AND DIFFERENCES BETWEEN THE
COMMON OBJECT AND WHAT YOU SAW.
thi
ne misille
2
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 YES,DESCRIBE.
A. DID THE PHENOMENON DISTURB THE GROUND OR LEAVE ANY PHYSICAL EVIDENCE. YES NO.
IF"YES,"DESCRIBE.
PAGE 7 OF 9 PAGES

-
. HAVE YOU EVER SEEN THIS OR A SIMILAR PHENOMENON BEFORE? YES NO. IF YES, GIVE DATE AND
LOCATION.
Can't'niunfobr, but wint
23. WAS ANYONE WITH YOU AT THE TIME YOU SAW THE PHENOMENON? AYES DID THEY SEE IT TOO?
YES NO.
A. LIST THEIR NAMES AND ADDRESSES
"You atriady tave thm, and hane sent thim form.
24. GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME, F RST NAME, MIDDLE NAME
ADDRESS (Str-et, City, State and Zip Code)
Kau hie 454414-
TELEPHONE Ao COdE and nunbEr) AGE
39 MALE FEMALE
INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT. INDICATE ADOITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT.
Heusenife
512532222-2
25. WHEN AND TO WHOM DID YOU REPORT THAT YOU HAD SIGHTED THIS PHENOMENON?
ded 2i luleih-in-liucd,tfat
NAME DAY_. MONTH. YEAR_
DAY_ MONTH_ 1.2 YEAR
PAGE 8 OF 9 PAGES
IT

1
27. INFORMATION WHICH YOU FEEL IS PERTINENT BUT WHICH IS NOT ADEQUATELY COVERED IN THIS QUESTIONNAIRE, ALTERNATIVELY PROVIDE A NARRATIVE EXPLANATION OF THE SIGHTING.
my hustandc callel wis all ant to watch the
liright light in the sby. It sumed to ueflict
aganst an abjict diictly abone and perhaps
attached to it. Kue to the wurzainding dark-
miod could not assertain ulat
it uas.
ae watehed it for alaut. fiftien minutes,
1
.
PAGE 9 OF 9 PAGES

2370067
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BASE. OHIO 4S433
MEPLY TO TDPT/UFO
ATTN OF:
UFO Observation, 23 November 1967 NOV 24 1967
BUBJECT:
TOI Mrs.
Speedy ,Indiana 45406
Your name has been given to the Aerial Phenomena Branch (Project
Blue I Book) as being a witness to an unidentified flying object.
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 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.
AMES C. MANATT, COlOneL, USAF AMES C. MANATT, COlOnel, USAF 1 Atch
Director of Production Production AF Form 117
-

deight bean feaw a
F
aitehe 8 lizb bellan on bllrana
rraibl th leplight
6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE 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.
17
90 1 13
1 8
1
1
. 1
1
1
1 15
1
OBSERVER
AF AUG 67 FORM 117

6A. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN "A* ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A B* ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMENON WHEN LAST SEEN.
B
A
N
NNW NNE
NW NE
WNW ENE
WSW ESE
SW 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
APPEAREO TO BE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW TO COMPLETE
THE LARGER SKETCH.
PAGE 2 OF 9 PAGES

I
WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCk aPPTOPRlate 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 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
NORTHWEST SOUTHWEST 0 YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS YOUR SKETCHES IN ITEMS S AND 6.
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 HOW MUCH OTHER TRAFFIC WAS THERE? OTHER TRAFFIC WAS THERE?
.
DID YOU NOTICE ANY AIRPLANES? 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. 9. HOW LONG HOW LONG WAS THE PHENOMENON WAS THE PHENOMENON IN SIGHT?
LENGTH OF TIME LENGTHOF TIME CERTAIN OF TIME NOT VERY SURE NOT VERY SURE
effax 15.me. FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMINED?
estimate
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY? FYES NO. IF NO, INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

1O. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WERS
ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING?
/
11. CONDiTioNs (Check appropriate blocks.)
A. SKY B. WEATHER I
DAY CUMULUS CLOUDS (LOW fluffy) FOG OR MIST
TWILIGHT CIRRUs CLouDs (High fleecy or Herring- HEAVY RAIN
NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
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 HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? YES NO. IF YES, WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT QVERHEAD (Nea noon)
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.
bean cle to
to che wine
its witte burmig itselp out on
i t the t
Nrth awny
eanyeng
t be less
it would offe
L
bright.
PAGE 4 OF 9 PAGES

yk bnight. Leiikie
Ch fonk T
cnd
Raure he
+
A. HOW DID IT FINALLY DISAPPEAR?
&ee &e 12. 18.
B. DID THE YES PHEYO - NO. := YES,° DESCRIBE.
PAGE 5 OF 9 PAGES

.. 23 Yiss67.
Ohis
TDPTR
Lt. Col. Smith
Request wind velocity and direction for
Dayton, Ohio 23 November 1967 between 2l00
and 2200 hours at surface and 6,000 feet.
- +
5 Dec 67
TDPTUFO)
70916
V
c
745-296

15. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT
HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
x=
18. WHAT WAS THE ANGULAR SIZEI HOLO A MATCH AT ARM'S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET
LAMP OR THE MOON. NOTE HOW MUCH OF THE OBJECT IS COVERED BY THE HEAD OF THE M "CH. NOW IF YOU HAD
BEEN ABLE TO PERFORM THIS EXPERIMENT AT THE TIME OF THE SIGHTING, ESTIMATE WHAT FRACT'  OF THE
PHENOMENCM YOULD HAVE BEEN COVERED BY THE MATCH HEAD.
21.
/
PAGE 6 OF 9 PAGES

—
17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUDE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDOWPANE OTHER
A. DO YOU ORDINARILY WEAR GLASSES? YES NO B. DO YOU USE READING GLASSES? YESNO
18. WHAT WAS YOUR IMPRESSION OF THE SPEED OF THE 3.
PHENOMENON? GIVE ESTIMATE OF SPEED PHENOMENON? GIVE ESTIMATE OF DISTANCE.
2O. IN OROER THAT WE MAY OSTAIN AS CLEAR A PICTURE AS POSSIBLE OF WHAT YOU SAW, DESCRIBE IN YOUR OWN WORDS
A GOMMCN CBJECT 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.
affiene snilen te lights clepfer
light
at suight feos an ai ept t lijlt u am
ania such as io sein ui snori ae eael
in cin combat ti light ug a 22 baeth fikd buitl fikel aria. ania
combat ti light ng
.
21, OID YOU NOTICE ANY ODOR, NOISE, OR HEAT EMANATING PROM THE PHENOMENON OR ANY EFFECT ON YOURSELF,
ANIMALS OR MACHINERY IN THE VICINITY? YESNO.IFYES, DESCRIBE.
YES HO.
IF "YES," DESCRIBE.
PAGE 7 OF 9 PAGES

-
22. HAVE YOU EVER SEEN THIS OR A SIMILAR PHENOMENON BEFORE? ESNOIF *YES,GIVE DATE AND
LOCATION.
Lee 2 Boch esi Conlnt and iin anorci
23. WAS ANYONE WITH YOU AT T E TIME Y ou W THE PHEN ENON? DID IT TOO?
YES NO.
A. LIST THEIR NAMES AND ADDRESSES
che othn
has alvend receind smiler
24. GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME, FIRST NAME MIDDLE NAME
ADDREss (Street, City, State and Zip Code)
DifyteN ofe 45416
TELEPHONE arar code and numbEr) AGE
4.3 MALE FEMALE
INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT.
yotgeg lon offien, montgge loen ff cen
25. WHEN AND TO WHOM DID YOU REPORT THAT YQU HAD SIGHTED THIS PHENOMENON?
te WORFB
NAME DAY_2.3 MONTH._ YEAR 67
26. DATE MPLETED THIS QUESTIONNAIRE.
DAY_3 MONTH_ 12 YEARZ
PAGE 8 OF 9 PAGES

237067
DEPARTMENT OF THE AIR FORCE
HEAQQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON 45433
REPLY TO
ATTN OP: TDPT/UFO
SUBJECT: UFO Observation ; 23 Novetber 1967 N0 234 1967
TO:
Speedway, Indiana 46224
Reference your recent unidentified flying object sighting which
you reported to the Air Force. The information which we have
received is not sufficient for a scientific investigation. Request
you complete the attached AF Form ll7 and return it in the self-
addressed envelope. Thank you for reporting your observation to addressed envelope. Thank you for our observation to
the Air Force.
MES C. MANATT, COlOnel, USAF 1 Atch
Lirector trector oduction AF Form 117

OD R
BOB Nr 21-R258
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE -
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 HAVE OBSERVED. PLEASE TRY TO
ANSWER ALL OF THE QUESTIONS. HE INFORMATION YOU GIVE WILL BE USED FOR RESEARCH PURPOSES.
YOUR NAME WILL NOT BE USED IN C
YOUR PERMISSION. RETURN TO AIR CE BASE INVESTIGATOR FOR FORWARDING TO FTD (TDETR), WRIGHT-
PATTERSON AFB, OHIO 45433, IAW S0-17 IF ADDITIONAL SHEETS ARE NEEDED FOR NARRATIVE OR SXETCHES
ATTACH SECURELY TO THIS FORM OR ANNOTATE WITH YOUR NAME FOR IDENTIFICATION.)
1. WHEN DID YOU SEE THE PHENOMENON?
2. WHAT TIME DID YOU F IRST SIGHT THE PHENOMENON?
HOUR2120MINUTES -A.M. P.M.
3. WHAT TIME DID YOU LAST SIGHT THE PHENOMENON?
HOUR 2/21MINUTES_ A.M. P.M.
4. TIMELZONE DAYLIGHT SAVINGS
EASTERN CENTRAL MOUNTAIN PACIFIC OTHER
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
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK.
de le
alaytonalu
Daytin
N N
&
-
1
6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE 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
1
1
1
1
1
1
1 15
OBSERVER
AF FORM 117
AUG67

GA. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN *A* ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A *B° ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMZNON WHEN LAST SEEN.
N
-
NNW NNE
NW NE
WNW ENE
WSW ESE
sw 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 BE STRAIGHT, CURVED OR ZIG-ZAG. REFER TO SMALLER SKETCH AS AN EXAMPLE OF HOW TO COMPLETE
THE LARGER SKETCH.
,
PAGE 2 OF 9 PAGES

/
8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCK aPpTOPRlate blocKs.)
OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING IN RESIDENTIAL SECTION OF CITY
IN CAR AS DRIVER C AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR AIRFIELD
IN AIRPLANE 0 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
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS 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
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW MUCH OTHER TRAFFIC WAS THERE? HOW MUCH OTHER TRAFFIC WAS THERE?
DID YOU NOTICE ANY AIRPLANES? 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. THEY WERE IN THE SKY RELATIVE TO THE POSITION OF THE PHENOMENON.
9. HOW LONG WAS THE PHENOMENON WAS THE PH ENOMENON IN SIGHT? IN SIGHT?
LENGTH OF TIME CERTAIN CERTAIN OF OF TIME NOT VERY SURE NOT VERY SURE
5 mm FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMINED?
Usitors depAotiss,
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY? YES NO. IF NO, INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

-
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 DURING THE SIGHTING?
1
11. CONDITiONS (Check appropriate blocks.)
A. SKY B. WEATHER I
DAY CUMULUS CLOUDS (LOW fluffy) FOG OR MIST
TWILIGHT CIRRus CLouDs (High fleecy or Herring- HEAVY RAIN
NIGHT bone) LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Roin) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
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 S AND MOON?
(1) STARS (2) MOON
NONE BRIGHT MOONLIGHT NO MOONLIGHT
A FEW A FEW MOON WITH HALO UNKNOWN UNKNOWN
MANY MANY MOON HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter) PARTIAL(New or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? 0 YES NO. NO. IF "YES, YES. WHERE WAS THE SUN AS YOU FACEO
THE PHENOMENON? THE PHENOMENON?
IN FRONT OF YOU IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (Near nOOn) OVERHEAD (Near noon)
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 AND WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER
IT WAS SOLID OR TRANSPARENT, WHETHER EDGES WERE SHARP OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT
APPEARED AS A POINT OF LIGHT. INDICATE COMPARISONS WITH OTHER OBSERVED OBJECTS, LIKE STARS, A LIGHT OR
OTHER OBJECT IN YOUR FIELD OF VIEW.
Con, similan to
3e
vesible lut binghti
PAGE 4 OF 9 PAGES

FLASH OR FLICKERI
DISAPPEAR AND REAPPEAR?
SPIN LIKE A TOP?
MAKE A NOISE?
FLUTTER OR WO3BLE? X
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON?
Putter Called the ostede
A. HOW DID IT FINALLY DISAPPEAR?
fost i trees. fost i thees.
B.DID THE PHENOMENON MOVE BEHIND ORIN FRONT TREE, OR BUILDING AT ANY TIME?
CTYES NO.IF *YES,DESCRIBE.
sigit ihid Thers
went ant
PAGE 5 OF 9 PAGES

1S. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
sN
(1
EI
.
16. WHAT WAS THE ANGULAR SIZE? HOLD A MATCH AT ARM'S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET
LAMP CR THE MOON. NOTE HOW MUCH OF THE OBJECT IS COVERED BY THE HEAD OF THE MA CH. NOW IF YOU HAD
BEEN ABLE TO PERFORM THIS EXPERIMENT AT THE TIME OF THE SIGHTING, ESTIMATE WHAT FRACTION OF THE
PHENOMENCN WOULO HAVE BEEN COVERED BY THE MATCH HEAD.
woudd have
Digect
head.
match
PAGE 6 OF 9 PAGES

6,000 230 15
22 Oct 67
REMARKS:
DATA SOURCE: ETAC DAta FiLeS
ANAIYST: SSgt Dunham
Ain.: :

-
17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUOE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSMIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDOWPANE OTHER
A. DO YOU ORDINARILY WEAR GLASSES? YES B. DO YOU USE READING GLASSES? YES NO
18. WHAT WAS YOUR IMPRESSION OF THE SPEED DOF THE I9. WHAT WAS YOUR IMPRESSION OF THE DISTANCE OF THE
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.
when itn
Compacalile t Venus
ni sighit
21. DID YOU NOTICE ANY ODOR, NOISE, OR HEAT EMANATING FROM THE PHENOMENON OR ANY EFFECT YOURSELF,
ANIMALS OR MACHINERY IN THE VICINITY? YES
A. DID THE PHENOMENON DISTURB THE GROUND OR LEAVE ANY PHYSICAL EVIDENCE. YES XN0.
IF"YES,"DESCRIBE.
PAGE 7 OF 9 PAGES

24. GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF
LAST NAME PIPST NAME, MIDDLE NAME
AbbREss (Stre City, State and Zip Code)
INdiANA.
TELEPHONE c code and numbeT) AGE 41
MALE FEMALE
INDYCATEAU ATONACNPORMATIC 10 12 onToArd MERTINENT
Nate: M Nate M
whow sighting w whow siglting as anle. as anle.
Occupti Electeial EagR. Allison D:0.6 Allison D:u.8
(exenal Moths
*Note: Note: A
Ave. Ae possibly Dossibly 90x goX photo of
oBject- 45405
2S. WHEN AND TO WHON DID YOU REPORT
YEAR567
26. DATE YOU COMPLETED THIS QUESTIONNAIRE. 1o√
DAY3MONTH_
PAGE 8 OF 9 PAGES

27. INFORMATION WHICH YOU FEEL IS PERTINENT BUT WHICH IS NOT ADEQUATELY COVERED IN THIS QUESTIONNAIRE,
ALTERNATIVELY PROVIDE A NARRATIVE EXPLANATION OF THE SIGHTING.
fone.
7
TI!
PAGE 9 OF 9 PAGES

.
PROJECT 10073 RECORD
1. DATE TIME GROUP LOCATION
26 Noveuber 67 Dayton, Ohio (Witness)
3. SOURCE 10. CONCLUSION
Ouvilian Cuvilian Possible (AIRCRAFT) Possible (AIRCRAFT)
. N.IMBER OF OBJECTS a. N.IMBER OF OBJECTS
Cne Che
-ENGTH OF OBSERVATION LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS 11. BRIEF SUMMARY AND ANALYSIS
1 Minute Observer sighted a bright star-like object that was going
6. 6. TYPE OF OBSERVATION TYPE OF OBSERVATION from east to west.
Ground-Visual Ground-Visuel
7. COURSE saw the object at 18lo hrs. On 26 Nov. nowever, on  Jec 67
a report was received from the observer listing the sigrting
E toW as 26 Dec 67. Since this date is impossible it is assuncd
8. PHOTOS that both forms are on the one sighting. The time is listeu
as 2llo on the second form. The observers description is
n Yes consistent with that of numerous aircraft that are in the
XXNo Dayton area.
9. PHYSICAL VIDENCE
Yes
XXNo
FORM
FTD SEP 63 0-329 (TDE) Previous sditlons of thls form may be ueed.
A
'

267067
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT.PATTERS SE. OHIO 45433
RIPLY TO ATTN OP: TDPT/UFO
107871967
UFO Observation, 26 November 1967
SUSJECT:
TO:
Dayton, Ohio 45427
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 26 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. 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.
JAMES C. MANATT, COlOnel, USAF 1 Atch
Director PY oduction AF Form 117
-
1T 1oT Shet I o Pigeest SheI, I o Pigeog
11

—
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC) WRIGHT.PATTI
RSON AIR FORCE BASE. OHIO 45433
RIPLY TO ATTN OF:
TDPT/UFO
NOV801
BUBJECT: UFO Observation, 26 November 1967
TO:
Dayton L0 45427
- - Reference your recent unidentified flying object sighting which Reference your recent unidentified flying object sighting which
you reported to the Air Force. The information which we have you reported to the Air Force. The information which we have
received is not sufficient for a scientific investigation. Request received is not sufficient for a scientific investigation. Request
you complete the attached AF Form ll7 and return it in the self- you complete the attached AF Form ll7 and return it in the self-
addressed envelope. Thank you for reporting your observation to the Air Force.
MES C. MANATT, COlOnel, USAF 1 Atch
Birector Production AF Form 117
. 1
1
-
i

BOB Nr 2l-R258
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE
THIS QUESTIONNAIRE HAS BEEN PREPARED SO THAT YOU CAN GIVE THE U.S. AIR FORCE AS MUCH INFORMATION
AS POSSIBLE CONCERN NTIFIED PHENOMENON THAT YOU HAVE OBSERVED. PLEASE TRY TO
ANSWER AI OUESTIONS INFORMATION YOU GIVE WILL BE USED FOR RESEARCH PURPOSES.
TH DUR STATEA OR CONCLUSIONS WITHOUT
YOUR PERMISSION. RETURN TO AIF E BASE INVESTIGATOR FOR FORWARDING TO FTD (TDETR), WRIGHT.
PATTERSON AFB, OHIO 45433, IAW 80-17 F 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?
DAY26NO√ MONTH. YEAR 6?
2. WHAT TIME DID YOU FIRST SIGHT THE PHENOMENON?
HOUR 1810 MINUTES A.M. P.M.
3. WHAT TIME DID YOU LAST SIGHT THE PHENOMENON? 3. WHAT TIME DID YOU LAST SIGHT THE PHENOMENON? 11
HOUR1811 HOUR MINUTES A.M. P.M. P.M.
4. TIME/ZONE DAYLIGHT SAVINGS STANDARD STANDARD
EASTERN CENTRAL MOUNTAIN PACIFIC PACIFIC OTHER
S. 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
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK.
, Daytan Daytor
5. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCN, PLACE 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
SHON HOW HIGH ABOVE THE HORIZON THE PHENOMENON WAS WHEN LAST SEEN.
A/B
57
15
OBSERVER
AF FORM 117
AUG 87

GA. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN A ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A B° ON THE COMPASS TO INDICATE THE DIRECTION TO
THE PHENOMENON WHEN LAST SEEN.
N
NNW NNE
NW NE
WNW ENE
WSW ESE
SW SE
sSw SSE
PAGE 2 OF 9 PAGES

8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (Check approprlate blocks.)
OUTDOORS IN BUSINESS SECTION OF CITY
IN BUILDING V RESIDENTIAL SECTION OF CITY
IN CAR AS DRIVER AS PASSENGER IN OPEN COUNTRYSIDE
IN BOAT NEAR 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 CIRECTION WERE YOU MOVING? HOW FAST WERE YOU MOVING?
NORTH EAST
SOUTH WEST DID YOU STOP ANYTIME WHILE OBSERVING THE
PHENOMENON?
NORTHEAST SOUTHEAST
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS YOUR SKETCHES IN ITEMS 5 AND 6.
DESCRIBE TYPE OF VEHICLE YOU WERE IN AND TYPE OF ROAD, TERRAIN OR BODY DESCRIBE TYPE OF VEHICLE YOU WERE IN AND TYPE OF ROAD, TERRAIN OR BODY OF OF WATER YOU TRAVERSED DURING
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW MUCH OTHER OTH ER TRAF T RAF FIC WAS W AS THERE?
DID YOU NOTICE ANY AIRPLANES? 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
min FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMINED?
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY? YES NO. IF "NO, INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
PAGE 3 OF 9 PAGES

1O. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WERZ
ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING?
oy
11. CONDITiONs (Check appropriate blocks.)
A. SKY B. WEATHER
DAY CUMULUS CLOUDS(Low fluffy) FOG OR MIST
TWILIGHT TWILIGHT CIRRUs CLOuDs (High fleecy or Herring- CIRRUs CLOuDs (High fleecy or Herring- HEAVY RAIN HEAVY RAIN
NIGHT bone) bbone) LIGHT LIGHT RAIN RAIN OR DRIZZLE
CLEAR NIMBUS CLOUOS( NIMBUS CLOUOS (Rain) (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET
COMPLETELY OVERCAST (Thunderstorms) (Thunderstorms) UNKNOWN
HAZE OR SMOG NONE NONE OF OF THE ABOVE
C. IF THE SIGHTING WAS AT TWILIGHT OR NIGHT, WHAT DID YOU 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 MOON WITH HALO UNKNOWN
MANY MOON HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter)
O. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? 0 YES XNO. IF *YES," WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (Near noon)
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 AND WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER
!T WAS SOLID OR TRANSPARENT, WHETHER EDGES WERE SHARP OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT
APPEARED AS A POINT OF LIGHT. INDICATE COMPARISONS WITH OTHER OSSERVED OBJECTS, LIKE STARS, A LIGHT OR
OTHER OBJECT IN YOUR FIELD OF VIEW.
bright as a sta
husmvond
a slir whit
ard a san - w
crdar crendar
i a fng lie a fin s sr but
L
PAGE 4 OF 9 PAGES

"1
232067
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIR FORCE BASE. OHIO 4B433
REPLY TO ATTN OF:
TDPT/UFO NOV 30 1967
SUBJECT: UFO Observation, 23 November 1967
TO:
Oto 45405
Reference your recent unidentified flying object sighting which
you reported to the Air Force. The information which we have
received is not sufficient for a scientific investigation. Reguest
you complete the attached AF Form ll7 and return it in the self-
addressed envelope. Thank you for reporting your observation to addressed envelope. Thank k you for reporting your observation to
the Air Force. the Air Force.
MES C. MANATT, COlOnel, USAF JMES C. MANATT, ColOnel, USAF 1 Atch
Mrector Production AF Form 117 AF Form 117
-
E

FLASH OR FLICKERI
DISAPPEAR AND REAPPEAR?
SPIN LIXE A TOP?
MAKE A NOISE?
FLUTTEROR WO39LE?
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON? 14. WHAT DREH YOUR ATTENTION THEPHENOMEN
nothig nothi Just fust
happened happered sel 1l it
A. HOW DID IT FINALLY DISAPPEAR?
ofsn went mtide
B. DID THE PHENCM MENON MOVE BEHIND OR IN FRONT OF SOMETHING, LIKE A CLOUD, TREE, OR BUILDING AT ANY TIME?
YES NO. IF *YES,DESCRIBE.
/
a
PAGE 5 OF 9 PAGES

15. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE
DIRECTION THE PHENOMENON WAS MOVING.
-O -O
16. WHAT WAS THE ANGULAR SIZE? HOLD A MATCH AT ARM*S LENGTH IN FRONT OF A KNOWN OBJECT, SUCH AS A STREET LAMP OR THE MOON. NOTE HOW MUCH OF THE OBJECT IS COVERED BY THE HEAD OF THE MATCH. NOW IF YOU HAD
PHENOMENON NOULD HAVE BEEN COVERED BY THE MATCH HEAD. BEEN ABLE TO PERFORM THIS EXPERIMENT AT THE TIME OF THE SIGHTING, ESTIMATE WHAT FRACTION OF THE
matshhiad mitsh hiad pufetly gond
purfertlyyours
PAGE 6 OF 9 PAGES

17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUDE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDDWPANE OTHER
A. DO YOU ORDINARILY WEAR GLASSES? YES B. DO YOU USE READING GLASSES? YES NO
18. WHAT WAS YOUR IMPRESSION OF THE SPEED OF THE. 15. WHAT WAS YOUR IMPRESSION OF THE DISTANCE OF THE
PHENOMENON? GIVE ESTIMATE OF SPEEO 1-8 PHENOMENON? GIVE ESTIMATE OF DISTANCE
inspees
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 PLACEO 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 OEJECT AND WHAT YOU SAW.
follin star ony slow folling stor ony slow
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 x NO. IF YES,DESCRIBE.
A. DID THE PHENOMENON DISTURB THE GROUND OR LEAVE ANY PHYSICAL EVIDENCE. YES NO.
IF *YES,"DESCRIBE.
/
PAGE 7 OF 9 PAGES
T

22. HAVE YOU EVER SEEN THIS OR A SIMILAR PHENOMENON BEFORE? YES NO.IF *YES,GIVE DATE AND
LOCATION.
same locton
23. WAS ANYONE WITH YOU AT TIME YOU SAW THE PHENOMENON? DID THEY SEE IT TOO?
YES NO.
A. LIST THEIR NAMES AND ADDRESSES
24. 24. GIVE THE FOLLOWING GIVE THE FOLLOWING INFORMATION ABOUT YOURSELF IN FO RMATION ABOUT YOURSELF
LAST NAME FIRST NAME MIDDI
ADDRESS (Street, City, State and Zip Code) ADDRESs (Street, City, State and Zip Code)
TELEPHONEMA TELEPHONEIA AGE X X
14 MALE FEMALE
INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND AND ANY ANY EXPERIENCE WHICH MAY BE PERTINENT. EXPERIENCE WHICH MAY BE PERTINENT.
schoof Coerdes m srine
25. WHEN AND TO WHOM DID YOU REPORT 25. WHEN AND TO WHOM DID YOU REPOR THAT YOU HAD SIGHTED THIS PHENOMENON? THAT YOU HAQISIGHTED THIS PHENOMENON?
us
n~o ol c-l
NAME DAY_ DAY_ MONTH YEAR
25.DATE YOU COMPLETED THIS QUESTIONNAIRE. NOV
DAY_ 26 MONTH. YEAR
PAGE 8 OF 9 PAGES

27. INFORMATION WHICH YOU FEEL IS PERTINENT BUT WHICH IS NOT ADEQUATELY COVERED IN THIS QUESTIONNAIRE, ALTERNATIVELY PROVIDE A NARRATIVE EXPLANATION OF THE SIGHTING.
1
PAGE 9 OF 9 PAGES

sPla ane if i
send ne a form

/
BOB Nr 21-R258
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 HAVE OBSERVED. PLEASE TRY TO
ANSWER ALL HE QUESTIONS E INFORMATION YOU GIVE WILL, BE USED FOR RESEARCH PURPOSES.
YOUR NAME WILL NOT BE USED IN COI ECTION WITHANY OURSTATEN ITS OR CONCLUSIONS WITHOUT
YOUR PERMISSION. RETURN TO AIR FORCE BASE INVESTIGATOR FOR
PATTERSON AF3, OHIO 45433, IAW 80-17. (I ADDITIONAL SHEETS ARE NEEDI D FOR NARRATIVE OR SKETCHES
ATTACH SECURELY TO THIS FORM OR ANNOTATE WITH YOUR NAME FOR IDENTIFICATION.)
. WHEN DTD YOU SEE THE PHENOMENON? 26 e
26, 1967 DAY_ MONTH YEAR.
2. WHAT TIME DID YOU FIRST SIGHT THE PHENOMENON? 9
HOUR MINUTES A.M. DP.M.
. WHAT TIME DID YOU LAST SIGHT THE PHENOMENON? 9
HOUR MINUTES A.M. P.M.
ROO
4. TIME/ZONE DAYLIGHT SAVINGS STANDARD 0 STANDARD
EASTERN CENTRAL MOUNTAIN PACIFIC OTHER
5. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? IF IN CITY, GIVE THE NEAREST STREET ADDRESS AND INDICATE ON 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
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK. HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLELANOMARK.
Rea Rean
6. IMAGINE YOU ARE AT THE POINT SHOWN IN THE SKETCH, PLACE 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.
1
8
B
I
1
1 30 30
I
1
1 1 15
OBSERVER OBSERVER
AF FORM 117
AUG 67
alsose DC N0V.18/0l00

6A. NOW IMAGINE YOU ARE AT THE CENTER OF THE COMPASS ROSE. PLACE AN A° ON THE COMPASS TO INDICATE THE
DIRECTION TO THE PHENOMENON WHEN FIRST SEEN. PLACE A *U° ON THE COMPASS TO INOICATE THE DIRECTION TO THE PHENOMENON WHEN LAST SEEN.
N
NNW NNE
NW NE
WNW ENE
OHL1
WSW ESE
sw SE
SSW SSE
PAGE 2 OF 9 PAGES

8. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? (CheCk aPPrOpRlate 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 AIRFIELD
IN AIRPLANE AS PILOT 0 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
NORTHWEST SOUTHWEST YES NO
EXPLAIN WHETHER SUCH MOVEMENT EFFECTS YOUR SKETCHES IN ITEMS S AND 6.
?
a
DESCRIBE TYPE OF VEHICLE YOU WERE IN AND TYPE OF ROAD, TERRAIN OR BODY DESCRIBE TYPE OF VEHICLE YOU WERE IN AND TYPE OF ROAD, TERRAIN OR BODY OF OF WATER YOU TRAVERSED DURING WATER YOU TRAVERSED DURING
THE SIGHTING. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN. STATE WHETHER WINDOWS OR CONVERTIBLE TOP WERE UP OR DOWN.
HOW MUCH HOW MUCH OTHER TRAFFIC OTHER TRAFFIC WAS THERE?
DID YOU NOTICE ANY AIRPLANES? DID YOU NOTICE ANY AIRPLANES? YES x NO. IF YES," DESCRIBE WHEN THEY WERE IN SIGHT RELATIVE TO THE TIME 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 PH ENO MENON IN SIGHT?
LENGTH OF CERTAIN OF TIME NOT VERY SURE
Dany
mmun FAIRLY CERTAIN JUST A GUESS
HOW WAS TIME DETERMINED? awas
Sust dark
WAS THE PHENOMENON IN SIGHT CONTINUOUSLY? X YES NO. IF NO, INDICATE WHETHER THIS IS DUE TO YOUR
MOVEMENT OR THE BEHAVIOR OF THE PHENOMENON, AND DESCRIBE SUCH MOVEMENT OR BEHAVIOR. INDICATE DISAP-
PEARANCES ON PREVIOUS SKETCHES.
and it
d fust watched it
still
ws
PAGE 3 OF 9 PAGES

10. IF THERE WERE MORE THAN ONE PHENOMENON, HOW MANY WERE THERE? DRAW A PICTURE TO SHOW HOW THEY WERT
ARRANGED. DID THIS ARRANGEMENT CHANGE DURING THE SIGHTING?
11. CONDiTiONs (Check appropriate blocks.)
A. SKY B. WEATHER I
DAY CUMULUS CLOUDS (Low fluffy) FOG OR MIST
TWILIGHT CIRRus CLouDs (High fleecy or Herring- HEAVY RAIN
NIGHT NIGHT bbone) bone LIGHT RAIN OR DRIZZLE LIGHT RAIN OR DRIZZLE
CLEAR NIMBUS CLOUDS (Rain) NIMBUS CLOUDS (Rain) HAIL
PARTLY CLOUDY CUMULONIMBUS CLOUDS SNOW OR SLEET SNOW OR SLEET
COMPLETELY OVERCAST (Thunderstorms) UNKNOWN
HAZE OR SMOG NONE OF THE ABOVE
C. IF THE SIGHTING WAS AT TWILIGHT OR NIGHT, WHAT C. IF THE SIGHTING WAS AT TWILIGHT OR NIGHT, WHAT DID DID YOU NOTICE ABOUT THE STARS THE STARS AND MOON?
(3) STARS (2) MOON
NONE NONE BRIGHT MOONLIGHT NO MOONLIGHT
A FEW A FEW MOON WITH HALO MOON WITH HALO UNKNOWN
MANY MOON HIDDEN BY CLOUDS
UNKNOWN PARTIAL (New or quarter)
D. IF SIGHTING WAS IN DAYLIGHT, WAS THE SUN VISIBLE? YES NO. IF WHERE WAS THE SUN AS YOU FACED
THE PHENOMENON?
IN FRONT OF YOU TO YOUR RIGHT OVERHEAD (Near noon)
IN BACX OF YOU TO YOUR LEFT UNKNOWN
E. SPECIFY THE MAJOR SOURCE OF ILLUMINATION PRESENT I DURING THE SIGHTING, SUCH AS THE SUN, HEADLIGHTS OR
STREET LAMP, ETC. FOR TERRESTRIAL ILLUMINATION, SPECI ANCE TO LIGHT SOURCE.
LIGHT
12. GIVE A BRIEF DESCRIPTION OF THE PHENOMENON, INDICATING WHETHER IT APPEARED DARK OR LIGHT, WHETHER IT
REFLECTED LIGHT OR WAS SELF-LUMINOUS AND WHAT COLORS YOU NOTICED. DESCRIBE YOUR IMPRESSION OF WHETHER
IT WAS SOLID OR TRANSPARENT, WHETHER EDGES WERE SHARP OR FUZZY. DESCRIBE THE SHAPE OR INDICATE IF IT
APPEARED AS A POINT OF LIGHT. INDICATE COMPARISONS WITH OTHER OBSERVED OBJECTS, LIKE STARS, A LIGHT OR
OTHER OBJECT IN YOUR FIELD OF VIEW.
ligat
Lell Luminous
w
solid
Bright as star
PAGE 4 OF 9 PAGES

. =-
BOB Nr 21-R258
SIGHTING OF UNIDENTIFIED PHENOMENA QUESTIONNAIRE
THIS QUESTIONNAIRE HAS BEEN PREPARED SO THAT YOU CAN GIVE THE U.S. AIR FORCE AS MUCH INFORMATION
AS POSSIBLE TIFIED PHENOMENON THAT YOU HAVE OBSERVED. PLEASE TRY TO
ANSWER INFORMATION VOU GIVE WILL BE USED FOR RESEARCH PURPOSES.
YOUR NAME WN TION WITH ANY OF YOUR STATEMENTS OR CONCLUSIONS WITHOUT
YOUR PERMISSION. RETURN TO AIR FORCE BASE INVESTIGATOR FOR FORWARDING TO FTD (TDETR), WRIGHT-
PATTERSON AFB, OHIO 4S433, IAW 8O-17. (IF ADDITIONAL SHEETS ARE NEEDED FOR NARRATIVE OR SKETCHES
ATTACH SECURELY TO THIS FORM OR ANNOTATE WITH YOUR NAME FOR IDENTIFICATION.)
1. WHEN DIO YOU SEE THE PHENOMENON?
DAY_2.3 MONTH. NOU YEAR 1967
WHAT TIME DID YOU FIRST SIGHT THE PHENOMENON?
App. HOUR
. WHAT TIME DID YOU LAST SIGHT TME PHENOMENON?
Are HOUR MINUTESA.M. XP.M.
4. TIME/ZONE DAYLIGHT SAVINGS STANDARD
EASTERN CENTRAL MOUNTAIN PACIFIC OTHER
5. WHERE WERE YOU WHEN YOU SAW THE PHENOMENON? IF IN CITY, GIVE THE NEAREST STREET ADDRESS AND INDICATE ON
A HAND DRAWN MAP WMERE YOU WERE STANDING WITH REFERENCE TO THE ADDRESS. IF IN THE COUNTRY, IDENTIFY THE
HIGHWAY YOU WERE ON OR NEAR AND TRY TO FIX A DISTANCE AND DIRECTION FROM SOME RECOGNIZABLE LANDMARK.
KENicoRr AUE DEAKAREAVE DEAWACEAVE
e Ae.
N.>
6. IMACINE YOU ARE AT THE POINT SHOWN IN THE SKETCN, PLACE 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 HCW HIGH ABOVE THE HORIZON THE PHENOMENON WAS WHEN LAST SEEN.
1 12
1
!
1
1
1
1
1 15
1
OBSERVER
AF FORM 117
AUG 67

STAND STILL AT ANYTIME?
SUDDENLY SPEED UP AND RUN AWAY?
BREAK UP IN PARTS AND EXPLODE?
4
CHANGE COLOR!
GIVE OFF SMOKE?
CHANGE BRIGHTNESS?
CHANGE SHAPET
FLASH OR FLICKERI
DISAPPEAR AND REAPPEAR?
SPIN LIKE A TOP?
MAKE A NOISET
FLUTTER OR WOEBLE?
14. WHAT DREW YOUR ATTENTION TO THE PHENOMENON?
Just looked
d gust looked y yo
A. HOW DID IT FINALLY DISAPPEAR?
B. DID THE PHENOA CN MOVE BEHIND OR IN FRONT OF SOMETHING, LIKE A CLOUD, TREE, OR BUILDING AT ANY TIME?
YES NO. IF *YES,"DESCRIBE.
PAGE 5 OF 9 PAGES
a

15. DRAW A PICTURE THAT WILL SHOW THE SHAPE OF THE PHENOMENON. INCLUDE AND LABEL ANY DETAILS THAT MIGHT HAVE APPEARED AS WINGS OR PROTRUSIONS, AND INDICATE EXHAUST OR VAPOR TRAILS. INDICATE BY AN ARROW THE DIRECTION THE PHENOMENON WAS MOVING.
C )
T
PHENOMENON PHENOMENON
16. WHAT WAS THE ANGULAR 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 OBJECT IS COVERED BY THE HEAD OF THE MA CH. NOW IF YOU HAD
BEEN ABLE TO PERFORM THIS EXPERIMENT AT THE TIME OF THE SIGHTING, ESTIMATE WHAT FRACTIOW OF THE PHENOMENON WOULD HAVE BEEN COVERED BY THE MATCH HEAD.
2t would cover tho mateh head. 2twould covenr sho matah head
PAGE 6 OF 9 PAGES
1:1

17. DID YOU OBSERVE THE PHENOMENON THROUGH ANY OF THE FOLLOWING? INCLUDE INFORMATION ON MODEL,
TYPE, FILTER, LENS PRESCRIPTION OR OTHER APPLICABLE DATA.
EYEGLASSES CAMERA VIEWER
SUNGLASSES BINOCULARS
WINDSHIELD TELESCOPE
SIDE WINDOW OF VEHICLE THEODOLITE
WINDDWPANE OTHER
A. DO YOU ORDINARILY WEAR GLASSES? B. DO YOU USE READING GLASSES? YES NO
18. WHAT WAS YOUR IMPRESSION OF THE SPEED $J\mp 19. WHAT WAS YOUR IMPRESSION OF THE DISTANCE OE 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, DESCRISE IN YOUR OWN WORDS
A COMMON CBJECT 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 CEJECT AND WHAT YOU SAW.
as big a as a Stan aslan
a a a
doy
t in The ar,
going going
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 YES,DESCRIBE.
A. DID THE PHENOMENON DISTURB THE GROUND OR LEAVE ANY PHYSICAL EVIDENCE. 0 YES NO.
IF *YES,"DESCRISE.

NO. IF YES, GIVE DATE AND
LOCATION.
summer
23. WA3 ANYONE WITH YOU A T TH E TIME Y ou SAW THE YES IT TOO?
YES NO.
A. LIST THEIR NAMES AND ADDR
24. GIVE THE FOLLOWING INEORMATION ABOUT YOURSELF
LAST NAME, FIRST NAME, MIDDLE NAM
ADDREsS (Street, City, State and Zip Code) ADDREss (Street, City, State and Zip Code)
sso ToOtu5 Oug542
TELEPHONE(Area code and number) AG AGI
10 110 Phone Phove MALE FEMALE
INOICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT. INDICATE ADDITIONAL INFORMATION INCLUDING OCCUPATION AND ANY EXPERIENCE WHICH MAY BE PERTINENT.
t student at Madisongr.
7.
igh.
25. WHEN AND TO WHOM DID YOU REPORT YOU REPORT THAT YOU HAD SIGHTED THIS PHENOMENON?
NAME DAY_. DAY. MONTH MONTH YEAR
26. DATE YOU COMPLETED CO THIS QUESTIONNAIRE.
DAY 28 MONTH O. YEAR6
PAGE 8 OF 9 PAGES