March 1953 | Elmira, New York
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U.S, AIR FORCE TECHNICAL INFORMATION
This questionnaire has baen prepared so that you can give the 1J.S. Air Force as much
information as possible concerning the unidentified aerial phenomanon that you have observad.
Placse 1ry to answer as many questions as you possibly can. The information that you give will
ba used for research purposes, Your name will pot 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.
| 74 i November i 1965
| Aap rox Day Month Year
3. Time Zone;
_ ———
(Circle One): (0. _Eastsr
b. Cantral
c. Mountain
d. Pecitie
oc Erher ool a
(Circle One): a, Daylight Saving
b.__Stendar: Ln
{ 5. How long was object in sight? (Total Duration) MERI A 5 Bic
| Hours Minutes Saconds
Oo. F a9 ely e arta i n i d, Ju st a gues $
c. Not very sure
Ca.
| 5.1 How was time in sight determined? __..k7 cn cl
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i 5.2 Was ctiect in sight continuously?
1 a —— = : or wr - - = =a Sn mt cm 4 ——— ——— i me rr ——n = — ss om sl Fs A il — i
f
A. What was na zandition of the sky?
5 /
DAY
a. Bri gh rt
b, Cloudy
SEE LE " - — me — eS I —— = — rr: mm ES — = = rr m= ee am Tm mT = == oa = EC ETT Tm." = ee —
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a i a lL a el ER ll Rh i WE
7. IF you saw the objsct during DAYILICHT, where was ths SUN located as you lockad at the objact?
(Circle One): a. In front of you d. To your laft
b, In back of you. o, QOvarhsod
¢. To yourrignt f. Don’t remember
J
TL BORN
FT1D OCT 62 164 Thia form superandaas FTN 164, Jul bl, which la ochaolata,
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