1967-10-7280305-[ILLEGIBLE]

Document Text (OCR)

iQ, CONC... Possable { H i i 30, Hove you ever sean this, or a similar object before. |f so give date or dates ond | N 31, Was anyone else with you at the time you saw the object? (Circle One) Yes Qo 31.1 IF you answerad YES, did they see the object too? (Circle One) Yos No 31.2 Please list their names and addresses: 7 32, Please give the following information about yourself; ee Lost Nome | | | | | | | — te: Street Stote TELEPHONE NUMBER SE AGE SS SEX SS ie indicate any additional information...