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X-FILE No. C014
SAMPLE BLANK UFO REPORT FORM (PG 2)
DATE: WEDNESDAY FEBRUARY 18, 1953
REF: Reel T-3291 Record Group 24 Vol 17984 HQC-940-105 Part 1
A sample of a blank Unidentified Flying Object Report (FLYOBRPT) form designed by the Theta-12 group of Project Second Storey. (Page two of five).


                            - 2 -



12. Describe what you saw as briefly as possible in the following
    spaces:

    a.  Sound ___________________          b.  Shape ____________________

    c.  Colour __________________          d.  Size _____________________

    e.  Number __________________          f.  Light brightness _________

    g.  Light Color _____________          h.  Motion ___________________

    i.  Speed ___________________          j.  Other ____________________

13. How did object disappear from view: Suddenly  or  Gradually
                                        _______________________
                                                Circle One

14. At any time did the object:
    a.  Change direction.  b.  Change speed.  c. Move behind something;
    Cloud, House, Tree, _______________  d.  Blend with background.
                          Other
    e.  Decrease in size.  f.  Decrease in brightness.  g.  Move in front
    of something.  h.  __________________________________________________
                                        Other
15. When you first looked at the object, what direction were you facing?
    ________________

16. When you last saw the object, what direction were you facing? _______

17. In the following Sketch A; draw lines

    from the observer's eye to the circular

    are to show the apparent elevation of the

    object in the sky.                      Directly
                                            Overhead
    A.  When first seen, label a.              |.
                                               |  \
    B.  When last seen, label b.               |    \
                                               |      \
                                               |        \
                                            ---|0----------------------
                                            Observerr's        Horizon
                                               Eye
                                                       SKETCH "A"

Copyright 1997 Joseph Daniels, All Rights Reserved