The Pine Bush Anomaly Archive c/o C. Burns PO Box 612 Far Hills, NJ 07931 pbmysteries@gmail.com 1-845-940-5000 Thank you for contributing the to Archive project. Please read the Description and Permission sections as well as the Anonymity choices before filling out the form. Submitted reports may be incorporated into five projects being developed by C. Burns, Linda Zimmermann and Vincent Polise (Authors): a database of accounts/stories/folklore intended for local historical groups in the Pine Bush, New York area as well as select anomaly researchers worldwide, as well as three book projects with working titles The Pine Bush Phenomenon, The Pine Bush Chronicles, and The Pine Bush UFO History (“the Work”). In addition there is planned a corresponding documentary. By submitting this report form and any corresponding materials (“Interview Materials”) you have agreed to assist Authors in preparation of the work. Permission: I hereby grant Authors, and their licensees, successors and assigns, the following non-exclusive rights in connection with the Interview Materials for use as part of the Work, or any advertising, packaging or promotional materials for the Work, in any and all editions, versions, and media, in perpetuity and throughout the world. 1. The right to quote or paraphrase all or any portion of the Interview Materials, and to generally use and publish the interview materials, including my experiences, recollections, incidents, remarks, characters, dialog, actions, scenes, situations and information, as well as any photographs or documents that I may give to Authors. 2. If choosing to be represented by my name as opposed to an anonymous witness number as per the section of this report form titled Anonymity, the right to use my name, image, voice, likeness, and biographical data. 3. The right to develop, produce, distribute, advertise and promote the Work as a book, film, or any other work in any manner the Authors deem appropriate. I understand and acknowledge that Authors will be the sole owners of all copyright and other rights in and to the Work. In order to enable Authors to develop the Work in any manner Authors may deem best, I hereby release and discharge the Authors and their licensees, successors and assigns, from any and all claims, demands or causes of actions that I may have against them by reason of anything contained in the Work, or any of the above uses, including any claims based on the right of privacy, the right of publicity, copyright, libel, slander, or any other right. I acknowledge and agree that I am not entitled to receive any form of payment from Authors and/or their licensees, successors and assigns. Agreed and confirmed: Name and date Report Form for Aerial and Exterior Anomalies v.1.1 QUICK DIRECTIONS: Perform a “save as” function on this report form text file and name it in this format: last name, first name, and number 1 if it is your first form submitted. To fill out report form, simply insert word processor cursor after questions and type response. Upon completion, email report form file as an attachment to pbmysteries@gmail.com, or burn completed report form to a CD-R and mail to the address at the top of this file. Notes: The “CONFIDENCE” rating is designed primarily for both older reports as well as for experiences where perceptions are seemingly altered. It is a fact of human nature that memory and perceptions are not always distinct and clear. Rather than ignore this fact, the Archive feels it is more constructive to allow witnesses the opportunity to document any questions they have with their own recollections, which will ultimately prove to benefit the proper documentation of their experience. The rating goes from “1-not confident” to “5-fully confident”, and witnesses are asked to put the appropriate number next to the rating on the questions it is attached to. CONTACT INFORMATION All address/email/phone information will be kept confidential unless requested otherwise. See “ANONYMITY” below as well. Name: Age: Occupation: Employer: Education level completed/degrees: Address: Phone Number: Email address: ANONYMITY: As this report may be adapted for inclusion in a database given to other worldwide researchers, and/or adapted for progress reports and/or the final results of the Archive‘s efforts, please mark your preference as to how you want to be represented as a witness by putting an X next to the appropriate selection: 1. I prefer and allow being represented by my full name 2. I prefer to be represented by a witness number, thereby making myself fully anonymous in any Archive report For experiences that occurred at personal residences or work locations: 1. Allow the inclusion of the specific location address in any Archive report 2. Do not use the specific location address in any Archive report EXPERIENCE ACCOUNT: In your own words, describe your experience/sighting. Take as much space as needed to write a full, detailed account: EXPERIENCE DETAILS: What was the date of your experience (month-day-year for exact)? Confidence (1 to 5): What was the time of day your experience began?: Confidence (1 to 5): What was the duration of the experience?: Confidence (1 to 5): What location marked the start of your experience? (include town/county/street/residence name): Confidence (1 to 5): What were you doing at the time the experience started?: Confidence (1 to 5): Were you inside a building or car, or outside at the start of the experience?: Confidence (1 to 5): If you were outside when you first noticed object/image, how long were you outside previous to the start of the experience?: Confidence (1 to 5): Were you standing up, sitting down, lying down, etc. at the start of the experience? Did you move as the experience progressed?: Confidence (1 to 5): What location marked the end of your experience, and how distant was this from your location at the start of your experience?: Confidence (1 to 5): Were there any other people present? Did they witness the object/image? If so, how was their attention drawn to the object/image?: If so, how many other people were present?: Confidence (1 to 5): Other witness names, contact information if known: WEATHER DETAILS: Cloud cover/Fog (describe amount/intensity if applicable): Confidence (1 to 5): Precipitation (describe amount/intensity if applicable): Confidence (1 to 5): Temperature: Confidence (1 to 5): Wind (if any, how strong, approximate direction): Confidence (1 to 5): Visibility of sun/moon/planets: Confidence (1 to 5): Any change in conditions during experience?: Confidence (1 to 5): ANOMALY DETAILS: How and why was object(s)/image(s) first noticed?: Confidence (1 to 5): How many objects/images were seen?: Confidence (1 to 5): Where was object/image located when first noticed ?(if possible include N,S,E,W orientation): Confidence (1 to 5): How far away from your location was object/image when first noticed (include estimated elevation if applicable)?: Confidence (1 to 5): If object/image is located in the sky, how far between the horizon and directly above your head was the object/image located? Use “0” for the ground, and “90” for directly above your head. Confidence (1 to 5): What was the appearance of the object/image when first noticed? (include shape, color, outline, comparison to familiar object): Confidence (1 to 5): What was the size of the object/image when first noticed?: (Use this method if needed: what could be held at arm’s length that would just cover the object/image? Examples could be: a penny, quarter, golf ball, orange, soccer ball, compact car, etc.): Confidence (1 to 5): How was object/image behaving when first noticed?: Confidence (1 to 5): Was the object illuminated in any way when first noticed? If so, how bright? (compare to full moon, streetlight, car headlight, etc.): Confidence (1 to 5): If experience was at early dawn, dusk or night, describe the level of ambient light. For instance, could you see the surrounding area’s details? Could the horizon be seen?: Confidence (1 to 5): If object/image was illuminated, how bright was it compared to the background ambient light?: Confidence (1 to 5): Did object’s/image’s behavior change as sighting progressed? If so, how and for how long?: Confidence (1 to 5): Did object’s/image’s appearance change as sighting progressed? If so, how and for how long? (include shape, color, outline, comparison to familiar object): Confidence (1 to 5): Did object/image change its location/distance as sighting progressed? If so, how and for how long? Include impressions of speed if possible using visual distance vs. seconds): Confidence (1 to 5): Did object’s/image’s illumination change during the experience?: Confidence (1 to 5): If object/image was airborne during the entire experience, what was the closest distance it had to the ground and at what point? Confidence (1 to 5): What was the closest distance to you that the object/image achieved, and at what point during the experience?: Confidence (1 to 5): Did the object/image pass over or in front of/behind any landmark in the environment during the experience? If so, how close was the landmark to you and how did the size of the landmark compare to the size of the object/image?: Confidence (1 to 5): Were you able to watch the object/image continuously during its time being visible? If not, how long did you watch the object for?: Confidence (1 to 5): Was any aid used in observing the object/image, such as binoculars, cameras, video cameras? If so, did these improve your observation?: Confidence (1 to 5): Where was object/image located when last seen? (if possible include N,S,E,W orientation): Confidence (1 to 5): How far away from witness location was object/image when last seen?: Confidence (1 to 5): What was the color/appearance of the object/image when last seen?: Confidence (1 to 5): How was object/image lost from sight?: Confidence (1 to 5): Was there any sound associated with the object/image?: Confidence (1 to 5): Was there any perceived temperature effect associated with the object/image?: Confidence (1 to 5): Was there any smell or scent associated with the object/image?: Confidence (1 to 5): PHYSIOLOGICAL: Was there any perception of an effect on the body i.e. skin, eyes, hair, stomach, etc. during the experience?: Confidence (1 to 5): Was there any perception of an effect on the body i.e. skin, eyes, hair, stomach, etc. after the experience?: Confidence (1 to 5): Were there any noticeable physical effects on other witnesses (if present)?: PSYCHOLOGICAL: Was there any change in consciousness during the experience?: Confidence (1 to 5): Was there any change in consciousness after the experience?: Confidence (1 to 5): Were there any changes in emotions during the experience? Confidence (1 to 5): ENVIRONMENT Was there any effect on the immediate surroundings from the object/image during the experience?: Confidence (1 to 5): Were there any physical changes of the environment after the experience? If so, why do you feel these are related to the object/image?: Confidence (1 to 5): Was there any notable conventional activity after the experience? (i.e. plane, car, sirens, etc.): Confidence (1 to 5): Were any animals present? If so, did they display any reaction to the object/image?: Confidence (1 to 5): OTHER: Were any photographs or audio/video recordings made during your experience by either you or another witness?: Did you contact any agencies after the experience, such as the police, airports, investigative groups?: WITNESS IMPRESSIONS: What was your first impression of what the object/image was when first sighted?: How did you feel before and during the experience?: How did you feel immediately after the experience?: What did you think you witnessed immediately after your experience?: If other witnesses were present, how did they act during the experience?: If other witnesses were present, how did they act immediately after the experience?: What are your thoughts currently about what you experienced/witnessed?: Did your beliefs about any aspect of life change after your experience?: Did your life change in any way that is attributable to your experience?: How would you describe your life at the time of your experience, and why?: ADDITIONAL WITNESS DETAILS: If residence at time of experience is different than your current residence, please note old residence: Address: If occupation/employer was different at time of experience, please note: Do you need corrective lenses to see distant objects clearly? If so, were you wearing these lenses at the time of your experience/sighting?: What is the nature of your eyesight? i.e. 20/20, farsighted, nearsighted, astigmatism, etc. : How would you describe your hearing? Do you wear a hearing aid?: Prior to the experience, did you have an interest in such topics as UFOs, ghosts, unusual creatures, psychic phenomena?: Prior to your experience, had anyone else in your family/friends/household had an interest in topics considered “supernatural” or “unknown”?: Prior to your experience, had you read any books, seen any movies, or read any magazines on topics considered “supernatural” or “unknown”, and what was your reaction to them?: Prior to this reported experience, have you had other anomalous experiences? If so, briefly describe: Since this experience, have you had any other anomalous experiences? If so, briefly describe (please fill out additional report forms if you feel it is of interest): Prior to your experience, were you aware of the reputation of the Pine Bush area for hosting anomalous experiences and UFO events? If so, how did you learn of the area’s reputation? What did you think about the area’s reputation?: Do you know of any other people who have experienced something unusual in the Orange/Ulster area?: What do you think the opinions are of the residents in and around the Orange/Ulster area concerning the reports of UFOs and anomalous experiences?: ADDITIONAL INFORMATION OR THOUGHTS: Please add any additional information you feel might be valuable to understanding your experience, as well as any thoughts you might have in regard to your experience. Thank you for contributing to the Pine Bush Anomaly Archive. A person associated with the Archive may contact you to follow-up this report.