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CIA RDP81R00560R000100010002 9
Page 13
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Approved For Release 2001/04/02 : CIA-RDP81R00560R000100010002-9
Was the object —
0. Self-luminous?
tL Dull finish?
c. Reflecting?
4. Transparent?
Did the object(s) rise or fall while in motion?
Tell the apparent size of the object(s) when compared with the following held at arm's length:
o. Pinhead 4. Nickel g- Orange
b Pee \ Half dollar fh. Gropefruit
a Dime fe Silver dollar ie Larger
Or, if easier, give apparent size in inches on a ruler held at arm's length.
How did you happen to notice the object(s)?
Where were you ond what were you doing at the time?
How did the object(s) disappear from view?
Compare the speed of the object(s) with a piston or jet aircraft at the same apparent altitude.
Were there any conventional aircraft in the location at the time or immediately afterwards? If so, please elaborate.
Please estimate the distance of the object(s).
What was the elevation of the object(s) in the sky? Please mark on this hemisphere sketch: 7 NN
Names and addresses of other witnesses, if any.
Please draw a map of the locality of the observation showing North; your position; the direction from which the object(s)
appeared and disappeared from view; the direction of its course over the area; roads, towns, villages, railroads, and other
landmarks within a mile.
Is there an airport, military, governmental, or research installation in the area?
Have you ‘seen other objects of an unidentified nature? If so, please describe these observations, using a separate sheet of paper.
Please enclose photographs, motion pictures, news clippings, notes of radio or television programs (include time, station and
date, if possible) regarding this or similar observations, or any other background material. We will return the material to you.
Were you interrogated by Air Force investigators? By any other federal, state, county, or local officials? If so, please state
the name ond rank or title of the agent, his office, ond details as to where and when the questioning took plac:
Were you asked or told not to reveal or discuss the incident? If so, were any reasons or official orders mentioned? Please
elaborate carefully.
We should like permission to quote your name in connection with this report. This action will encourage other responsible
citizens to report similar observations to NICAP. However, if you prefer, we will keep your name confidential. Please note
your choice by checking the proper statement below, In any case, please fill in all parts of the form, for our own confidential
files, Thank you for your cooperation.
You may use my name. Please keep my name confidential.
y
Date of filling out this report: Signature:
Approved For Release 2001/04/02 : CIA-RDP81R00560R000100010002-9
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