23857122-1022-446840-0003

RESTRICTED U. S. AIR FORCE TECHNICAL INFORMATION SHEET This questionnaire has been prepared so that you can give the U. S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you have observed. Please try to answer as many questions as you possibly can. The information that you give will be Used for research purposes, and will be regarded as confidential material. 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? 2. Time of day: _2° Hour 20 December Day Month (Circle One): A.M. Time zone: (Circle One): a. Eastern (Circle One): a. Daylight Saving b. Central b. Standard | (¢) Mountain , d. Pacific e. Other Where were you when you saw the object? oY 41, 4 ; A ial i \T Y pabaanr 2511 35th ste Los Alamos New Mexico Nearest Postal Address City or Town State or Country Additional remarks: Estimate how long you saw the object. Q 0 1Le5 Minutes Seconds 5.1 Circle one of the following to indicate how certain you are of your answer to Question 5. @) Certain c. Not very sure b. Fairly certain d. Justa guess What was the condition of the sky? gs 143.5 was at 2002 MST ~ GAvU | (Circle One): a. Bright daylight d. Just a trace of daylight b. Dull daylight e. No trace of daylight c. Bright twilight f. Don’t remember IF you saw the object during DAYLIGHT, TWILIGHT, or DAWN, where was the SUN located as you looked at - the object? Doesn't apply (Circle One): a. In front of you d. To your left b. In back of you e. Overhead c. To your right f. Don’t remember cc ECTDICTED / SO { wT, RE o> READ es Wy | | ia / iy) ry a ITY If IFORMATION } / f SECURI Hi AN kd FAs VO Declassification Authority: NND 57565