PROJECT BLUE BOOK

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1. When did you see the object:

1.1 Date: 2. ae ae AP aro.
ay Month /’ Year

1.2 Time of days __// 27 AM, orP.M,” (Circle One) {
Hrs. Min,

1.3 Time Zone: (Circle One):

ne — =

a, Mastern d. Pacific
de Ceritral 6. Other
c. Mountain

(Circle One): a, Daylight Saving
b. Standard

1.4 Circle one of the following to indicate how certain you are
of your answer to the above question 1.2:

o Gerteip c. Not very sure
airly certain d, Just a guess
2. Where aaa you see the me |
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J Sex Address City or Town State Country
3. Where were you located when you saw the object:
(Circle One): a. Inside a building a. In an airplane
b. Ina car e. At sea
Ce Outdoors” f. Other

3.1 Were you:

(Circle One): a. In the business section of a city?
b. In the residential section of a city?
(Co In open countryside?
d, Flying near an airfield?
e. Flying over a city?
f. Flying over open country?
ge Other

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4. How did you cig notice the object? __

5, When did you report to some official that you had seen the object?

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“Day Month Year

6 What were you doing at the time you saw the object? Bat FTE

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6.1 What-had you been doing for the 30 minutes vetoLe you saw the

object? Try to list the activity or activities, and the
approximate amount of time spent on each,

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7. Were you moving at any time ee saw the object? (Circle One):
Yes or (Bee)
IF you answered YES, then complete the following questions,
7.1 What direction were you moving?

(Circle One): a. North e. South
b. Northeast f. Southwest
c. East g. West
d. Southeast h. Northwest

7.2 How fast were you moving? miles per hour,
7.3 Did you stop at any time while you were looking at the object?
(Circle One): Yes or No

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8, What direction were you facing when you first saw the object?
(Circle One): a. North

e. South x
b. Northeast f. Southwest’
6, East g@. West
a. Southeast h. Northwest
8.1 What direction were you facing when the object disappeared?
(Circle One): a. North e. South :
b. Northeast £. Southwest’
Ce East Be West
a. Southeast h. Northwest

8.2 Circle one of the following to indicate how certain you are of
your answer to the above two questions, (8 and 8.1).

a. Certain» c. Not very sure
b, Fairly certain d,. Just a guess

9. Were you wearing eye glasses when you saw the object? (Circle One):
Yes cor No”

10. How was the object seen?

(Circle One): a. Through window glass 6. Through theodolite
b. Through windshield f. Through sun glasses
c. Through binoculars (ge Through open space
a. Through telescope h. Other
11. What do you remember about the weather conditions at the time you saw
the object?
11,1 CLOUDS (Circle One) 11.3 WEATHER (Circle One)
a. (Clear sky a. ( Dry}
b. Hazy b. Fog, Mist, or light rain
ce Scattered clouds c. Moderate or heavy rain
a. Thick or heavy clouds ad. Snow
e. Don't remember e. Don't remember
11.2 WMD (Circle One) 11,4 TEMPERATURE (Circle One)
a. (No wind) a. Cold
b. Slight breeze b. Cool
ce. Strong wind c, (Warm)
d. Don't remember de Hot

e. Don't remember

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12, Estimate how long you saw the object? | |
: . Hours Minutes “Seconds

‘12.1 Girole one of the following to iniicate how certain you are of
your answer to Question 12:

Bs Certain’) c. Not very sure
b. Fairly sure ad, Just a guess

13. Did the object look: (Circle One) Solid or Transparent?
14. Did the object at any time:

(Circle One for each question)

14.1 Change direction? ( Yea) No Don't_know
14.2 Change speed? ‘Yes: No Don't _know
14.3 Change size? Yes No Don't know
14.4 © color? tes = Ng )~=—Ss«éDegnn'& know,
14.5 Break up into parts or
i explode? Les No Don't_know
14-6 Give off smoke? Yes “No Don't know
14.7 Change brightness? Yes Bo Don't know
14.8 Flicker, throb, or

pulsate? ge 0 Don't know
14.9 Remain motionless? Don't know

15, Did the object give off a light? (Circle One): <Yes’ No Don't know
15.1 IF you answered YES, what was the color of the light? |

16. Tell in a few words the following things about the object?
16,1 Sound

16.2 Color DP A artvtg 2, Cd aerie £ ebb
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17. If there was MORE THAN ONE object, then how many were there?
Draw a picture of how they were arranged, and put an arrow to
show the direction they were traveling.

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18. Did the object at any time:
18.1 Move behind something? (Circle One) Yes No) Don't know
IF you answered YES, then tell what it moved behind.

18.2 Move in front of something? (Circle One) Yes No Don't know
IF you answered YES, then tell what it moved in front of,

18.3 Blend with the background? (Circle One) Yes No’ Don't know

19, Which of the following objects is about the same actual size as the
object you saw? (Circle One):

a. Pea f. Automobile

b. Baseball _ g. Small airplane
c. ( Basketball’ h. Large airplane
d. Bicycle wheel i. Dirigible

e. Office desk j. Other

19.1 Circle one of the following to indicate how certain you are
of your answer to Question 19.

a. Certain. _ @. Not very sure
b. (Fairly certain’ ad. Uncertain

20, Try to tell the following things about the object:

20.1 How high above the earth was it? SOA feet.
20.2 How far was it from you? ~~.” feet or miles

20.3 How fast was it going? 727 ‘7 __ miles per hour,

20.4 Circle one of the following to indicate how certain you are
of your answer to the above questions:

a. Certain ¢. «Not very sure”
b, Fairly certain: d. Just a guess

21. How did the object disappear from view?

(Circle One): a, < Suddenly » c. Other
b. Gradually d. Don't remember

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22. In the following sketch, imagine your eye at the point shown. Place an
"A" on the curved line to show how high the object was above the horizon
when you Arsh saw it, Place a "B" to show where it was when when you
last saw it.

Overhead

Horizon

Your eye

23. In the following sketch place an "A" at the position the object was
when you first saw it, and a "B" at its position when you last saw it,

Overhead

Horizon Horizon

Your eye

24. Draw a picture that will show the motion that the object made, Place
an "AY at the beginning of its path and a "B" at the end of its path.

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25. Draw a picture that will show the shape of the object. Label and include
in your sketch any details of the object that you saw, and place an arrow
beside the drawing to show the direction the object was moving,

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26. Was this the first time that you have seen an object like this?
(Circle One): Yes No

26.1 IF you answered NO, then when, where, and under what conditions
did you see other ones? |.

27. In your opinion what do ~~ think the object was and what might have
caused it?

28. Give the following information about yourself:

NAME SE a. —
t Hame First Name

Middle Name ;
Zone State
TELEPHONE NUMBER
What is your present job? FL» Hh Mf LAP : op

Age 4° ¢/

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Sex a : IA | i- Fo

Last School Attended +! 4. |
Year of last attendance at this school “4 ‘” .°