PROJECT BLUE BOOK

“4

. | TENTATIVE ot

OBSERVERS QUESTIONNAIRE

ECTION A

le When did you see the object:
1.1 Date: 43 Th

(VFL
“Day q. Month § Year

1.2 tise of Day? 5, (chomp) 40. A.M. or(P. (Cirele One) (ag

1.3 Time Zone: (Circle One): Cte 2
Eastern d. Pacific
de Central e. Other
ce Mountain ea ee

(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:

Certain ebgespl munsle c. Not very sure
. « Fairly certain. ad. Just a guess

en ‘%. Where were you when you saw the object:

Additional Remarks:

now LA? ft a ee san”, Bo hey hee : “ee re cc a
4 y
3. Where were you located when you saw the object: NI
(Circle One): a. Inside a building d. In an airplane :
b. Inacar e. At sea _ Lib
Ce Outdoors f. Other ree Berek. / N3
3.1 Were yous 2
(Circle One): ae In the business section of a city? ‘
In the residential section of a city?
, Ce In open countryside? he
d. Flying near an airfield? “\
e. Flying over a city?
f. Flying over open country?

Other

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—

he How did you happen to notice the object? “hers ow ertecte

t

fa a

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

“hay eth —«C car Ole Afar?

SECTION B

6. What were you doing at the time you saw the object? ~Saccralacagg talon,

6.1 What had you been doing for the 30 mimtes before you saw the object?
Try to list the activity or activities and the approximate amount
of time spent on each.

a . et onl
aren Aer eee

7. Were you moving at any time while you saw the object? (Circle One):

tes or (2)

IF you answered YES, then complete the following questions:
71 What direction were you moving?

(Circle One): a. North e. South
b. Northeast f. Southwest
Ce East ge West
ad. Southeast he Northwest

7e2 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

8. What direction were you looking when you first saw the object?

(Circle One): a. North ‘e) South
b. Northeast Southwest
ce East ge West

ad. Southeast he Northwest

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8.1 What direction were you looking when the object disappeared?

(Circle One): a. North fe.) South
b. Northeast r> Southwest
c. East g- West
da. Southeast he Northwest

8.2 Circle one of the following to indicate how certain you are of

= Spee to the above question and preceding question (8 and
el c

fa.) Certain c. Not very sure
S Fairly certain ad, dust a guess

9. Were you wearing eye glasses when you saw the object? (Circle One):
(ig) 3 & |
10. How was the object seen?

(Circle One): a. Through window glass e. Through theodolite
b. Through windshield f. Through sunglasses

c. Through binoculars Through open space
d. Through telescope « Other
11. What do you remember about the weather conditions at the time you saw the
object?
12.1 CLOUDS (Circle One) 11.3 WEATHER (Circle One)
a» Clear sky (ae) Dry
b. Hazy &% Fog, Mist, or light rain
G2 Scattered clouds ce. Moderate or heavy rain
> Thick or heavy clouds d. Snow
e. Don't remember ee Don't remember
11.2 WIND (Cirele One) 11.4, TEMPERATURE (Circle One)
ae No wind e Cold
be Slight breeze @) Cool
c, Strong wind Ce Warm
Don't remember d. Hot
ee Don't remember
SECTION C
12. Estimate how long you saw the object? ID

“~~Hours - fanutes Seconds —

ee ee ee ee ee eee Se ee

13.
ly.

15.

16.

17.

18,

—_- —] o-_ ~~~@

Page h

12.1 Circle one of the following to indicate how certain you are of your
“answer to Question 12:

a Certain Not very sure
b. Fairly sure d.) Just a guess

a
Did the object look: (Circle One) Solid or iy the, Bomet Oh.
Lag hi ir Lamotte by,

Did the object at any time:

(Circle One for each question)

14.1 Change direction? ~* Yes Don't know
14.2 Change speed? Yes i nf
1\.3 Change size? Yes ie ont t
1.45 Change color? Yes NO} n't know
14.5 Break up into parts or Yes (NO) n' ow
explode?
14.6 Give off smoke? Yes Don't know
1h.7 Change brightness? Yes if Don ow
14.8 Flicker, throb, or Yes 7  Dontt know
pulsate? >
14.9 Remain motionless? Yes (i) Don't know

Did the object give off a light? (Circle One): No Don't know

15.1 IF you answered YES, what was the color of the light? shat Deer Brgy

Tell in a few wrds the following things about the object? 4

16.1 Sound

16.2 Color . C ; Va

IF there was MORE THAN ONE object, then how many were there? - + oF an ” 3 be,
Draw a picture of how they were —— and put an arrow show ae i

direction they were ig

Oe ne,

Did the object at any time: nY\

oO

18,1 Move behind something? (Circle One) Yes No Gon't know)
IF you answered YES, then tell what it moved behind,

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ne ae.

18.2 Move in front of something? (Circle One) Yes te Don't. in t know)
IF you answered YES, then tell what it moved in front of.

_ ee
18,3 Blend with the background? (Circle One) ee sect Zz Don't know

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

« Pea f. Automobile
b. Baseball g- Small airplane
c. Basketball he Large airplane
& Bicycle wheel i. Dirigible

« Office desk j- Other

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

ae Certain c. Not very sure
b. Fairly certain do) Uncertain

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

20.1 How high above the earth was it? 254/06 2 “feet.

20.2 How far was it from you? gi 3 pee feet or miles
20.3 How fast was it going? miles per hour.

20. Circle one of the following ndicate how certain you are of your
answer to the above questions:

ae Certain Ce Not very sure
b. Fairly certain dust a guess
21. How did the object disappear from view? =
(Circle One): (a) Suddenly c. Other
>. Gradually d. Don't remember
SECTION D

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
(skyline) when you first saw it. Place a "B" to show vhere it was when
you last saw it. Seanad

Horizon

. Page 6

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

2h. Draw a picture that will show the motion that the object made. Place an
"A" at the beginning of its path and a "B" at the end of its path.

b

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.

ver) (o

ee

Page 7

SECTION ©

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

Ne”

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

27. In your opinion what do you think the object was and what might have caused

it?
a Mp aha. |

28, Give the following information about

woe _ Te —“Wadie ans
MIS oad = se

TELEPHONE NUMBER

What is your present job?

Age $7

Sex a

29. Was anyone else with you at the time you saw the object?

(Circle One): Yes or

29.1 IF you answered YES, did they see the object too?

(Circle One): Yes or No

29.2 Please list their names and addresses:

wba o wd b~

Page 8

30. Please add here any further comments which you believe are important,
Use additional sheets of the same size paper, if necessary.

yA Chewd ; ‘ tattle An
za oo eg ie RR ar

- cenmy hy Feu,
Aut «4 2 Gp Cha 2 ie am Aa feces.) foe

LN = Naga