1. |
Date reported: _________________ Time: ___________________ |
2. |
Date of occurrence:_____________ Time: ___________________ |
3. |
Nature of report: __UFO __Apparition __Animal __Other:_____________ |
4. |
Witnessed by: Name: ______________________________________________ |
| Address: __________________________________________________________ |
| City: ____________________________ State: _________ Zip: __________ |
|
Home Phone: (____) ______________ Business Phone:(____)___________ |
5. |
Additional Witnesses: |
| a. Name:________________________ Address: _______________________ |
| Phone: (____) _______________ _______________________ |
| b. Name:________________________ Address: _______________________ |
| Phone: (____) _______________ _______________________ |
| c. Name:________________________ Address: _______________________ |
| Phone: (____) _______________ _______________________ |
6. |
Geographic location of incident: |
|
Nation: _____________________ State/Province: ________________ |
| County: _____________________ Nearest City/Town: _____________ |
7. |
Exact location (Road/Nearest landmark, etc.) [Example: Near mile marker #71 on I-35] ___________________________________________________________________ |
8. |
Is there an Airport/Air Base/Military Base within a radius of 10 miles? __Yes __No. If “yes,” name of facility: _________________________ |
9. |
Estimated distance from observer’s location to Subject being reported: ___________________________________________________________________ |
10. |
How many Subjects were there? _________________________________________ |
11. |
Describe the Subject(s) in detail (if more space is needed, continue at end of form): ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
12. |
Was/were the Subject/s moving? ___Yes ___No
If moving, in what direction? __N __S __E __W __NE __NW __SE __SW Elevation: ________________________________ Azimuth: __________________________________ |
13. |
How long did the incident last? ____Seconds ____Minutes ____Hours |
14. |
Were any sounds associated with the incident? ___Yes ___No Any odors? ___Yes ___No If “yes,” describe: __________________________________________________________________________________________________________________ Were any other physical attributes associated with the event? _____ ___________________________________________________________________ ___________________________________________________________________ |
15. |
Summary of what happened (continue at end of form if necessary):
______________________________________________________________________________________________________________________________________ ___________________________________________________________________ |
16. |
Background of witness: _______________________________________________________________________________________________________________ |
17. |
Any other information you believe would be useful? ___________________________________________________________________________________ |
18. |
Does witness wish name to be kept confidential? __Yes __No |
19. |
Signature of witness: _____________________________________________Date: ____________________________ |
20. |
Investigator’s name (print): ______________________________________Investigator’s signature: _________________________________________ Date: ____________________________ |
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Use space below for additional information: |