PROJECT BLUE BOOK

‘ *

1. DATE - TIME GROUP 2. LOCATION
19 larch 53 19/253302
10. CONCLUSION

AIR Oita rv

Cojects could lieve been aircraft 2% hi:

5. LENGTH OF OBSERVATION /[11. BRIEF SUMMARY AND ANALYSIS

wt t — " avin ." —e >
Mot at pur ted ' ee a ' i.tt.. re oO Jy IC u&

6. TYPE OF OBSERVATION

9. PHYSICAL EVIDENCE

O Yes
CL’Ne

FORM
FTD sep 63 0-329 (TDE) previous oditions of this form may be used,

—- .9——

eV ¢
U. S$. AIR FORCE TECHNICAL INFORMATION maar it Kk
a? &

This questionnaire has been prepared so that you can give the U. S. Air Force as ‘euch
information as possible concerning the unidentified cerial phenomenon thot you have observed.
Please try to answer as many questions as you possibly can. The information that you give will
be used for research purposes, and will be regarded as confidential material. Your name will not
be used in connection with any statements, conclusions, or publications without your permission.
We request this personal information so that, if it is deemed necessary, we may contact you for

further details.

= mere a ie SSS SS eS a ee ee eee -|
1. When did you see the object? 2. Time of day: 19390 auproximatels
Hour Minutes
_19 March 1953
Day Month Yeor (Circle One): A.M. or P.M.
b — _ i — a ne a ne ee

3. Time zone:
(Circle One): af Eastern

b. Central
c. Mountain
d. Pacific

(Circle One): a. Daylight Saving

B. Standord

— —---- —--—_—-_--- -_ oC

4. Where were you when you saw the object?

_Zln Street

rystal Lake

*.s

Nearest Posto! Address

e. Other

Additional remarks: at

City or Town Stote or Country

. ine A

—

—_——- _—

5. Estimate how long you saw the object.

— ——— —

x

Hours

Ye. Certain.

b. Fairly certain

5.1 Circle one of the following to indicate how certain you are of your answer to Question 5,

c. Not very sure
d. Just o guess

Minutes Seconds

- ae ——_—

6. What was the condition of the sky?

(Circle One): a. Bright daylight
b. Dull dayligh:

%. Bright twilight

the object?

(Circle One): a. In front of you

b. In back of you
c. To your right

7. IF you saw the object during DAYLIGHT, TWILIGHT, or DAWN, where was the SUN located as yeu : booked ot

d. Just a trace of daylight
e. No trace of daylight
f. Don't remember

EE

d. To your left
e. Overhead

f. Don’t remember

a
_— ————

Page ?

8. IF you saw the object at NIGHT, TWILIGHT, or DAWN, what did you notice concerning the STARS and MOON?

8.1 STARS (Circle One): 8.2 MOON (Circle One):
%. None a. Bright moonlight
b. A few b. Dull moonlight
¢. Many c. No moonlight — pitch dark
d. Don’t remember d. Don’t remember

i |
9. Was the object brighter than the background of the sky?

(Circle One): a. Yes b. No ‘¢. Don't remember

10, IF it was BRIGHTER THAN the sky background, was the brightness like that of an automobile headlight?:

(Circle One) a. A mile or more away (a distant car)?
b. Several blocks away?

c. Ablock away?

d. Several yards away?

=e eo, Ow ..._.___ . 4 :
11, Did the object: (Circle One for each question) |
a. Appear to stand still at any time? Yes Don't Know
b. Suddenly speed up and rush away at any time? Yes Don't Know
c. Break up into parts or explode? Yes Don't Know
d. Give off smoke? Yes Don't Know
e. Change brightness? Yes Don't Know
f. Change shape? Yes Don’t Know
g- Flicker, throb, or pulsate? Yes Don’t Know |
12. Did the object move behind something at anytime, particularly a cloud?
(Circle One): Yes No Don’t Know. IF you onswered YES, then tell what |
it moved behind:
13. Did the object move in front of something at anytime, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, than tell what |
it moved in front of:
14, Did the object appeor: (Circle One): a. Solid? b, Transparent? c. Don't Know, |
15. Did you observe the object through any of the following? |
a. Eyeglasses Yes No e. Binoculars Yes No |
b. Sun glasses Yes No f. Telescope Yes No |
c. Windshield Yes No g- Theodolite Yes No

d. Window glass Yes No h. Other _

—_—_———_—_—_——

, (
16. Tell in a few words the following things about the object.
o. Sound iene

“b. Color

17. Draw a picture that will show the shape of the object or objects. Label and include in your sketch any details

of the object that you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails. Place
an arrow beside the drawing to show the direction the object was moving.

—_—$_$$_$_____ -—_——_——_ ——_

18. The edges of the object wore:

(Circle One): a. Fuzzy or blurred e. Other . — .
b. Like o bright stor
c. Sharply outlined ee Se
d, Don’t remember ——————KLLKLK—L —
19. IF there was MORE THAN ONE object, then how many were there? __2wo rosembling saucers  _-_.
Draw a picture of how they were arranged, and put an arrow to show the direction that they were travel ing.
Traveling at slow rate of sneeds fro:. Crystal | ekeMowords Yarrton.at about

35,000 feet-—-apneered to be abtovt 1" anart as he sav then
trail,

-~—Lwe No vanor

20. Draw a picture that will show the motion that the object or objects made. Place an “A” at the beginning
of the path, a “B® at the end of the path, and show ony changes in direction during the course.

Page 4

eae ae

21. IF POSSIBLE, try to guess or estimate what the real size of the object was in its longest dimension.
an ae

_

= eee _—_ - =

22. How large did the object or objects appear as compared with one of the following objects held in the hand
and at about arm’s length?

(Circle One): a. Head of a pin g-. Silver dollar
b. Pea h. Baseball
c. Dime i. Grapefruit
d. Nickel j. Basketball
e. Quarter k. Other

f. Half dollar
22.1 (Circle One of the following to indicate how certain you are of your answer to Question 22.

a. Certain c. Not very sure
b. Fairly certain d. Uncertain
23. How did the object or objects disappear from view? !: on_ wie.

—_/- ——— -_ —— —_-—

_ —_—_—

—_—__------r - ---——- -—— —— —_—_—

24. In order that you can give os clear o picture os possible of what you saw, we would like for you to imagine that you could
construct the object thet you sow. Of what type moterial would you make it? How lorge would it be, and whot shape
would it have? Describe in your own words a éommon object or objects which when placed up in the sky would give the
same oppearance as the object which you sow.

Poge 5

25. Whete were ‘you located when you saw the object? 26. Were you (Circle One)
(Circle One):

In the business section of a city?
a. Inside a building In the residential section of a city?

b. Ina car In open countryside? a
c. Outdoors Flying near an airfield?

d. In an airplane Flying over a city?

e. At sea f, Flying over open country?
Oe, ee g- Other

27. What were you doing at the time you saw the object, and how did you happen to notice it?

Son e@lied from mrt of decors to come and see «

28. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions:

28.1 What direction were you moving? (Circle One)

a. North c. East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
28.2 How fast were you moving? Ss samilless per hour,

28.3° Did you stop at any time while you were looking at the object?
(Circle One) Yes No

—_

ees se

——- —_—__—_—

29. Whot direction were you looking when you first saw the object? (Circle One)

a. North c. East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest

—_— ----—_- - Cr er > rcC le er -——- _ —

30. What direction were you looking when you last saw the object? (Circle One) ovar?s Derrton from Cece]
j

a. North c. East e. South g. West f
b. Northwest d. Southeast f. Southwest h. Northwest (Ar 2

_-—— eee —_—_—_— — ——— hc > OOO

ae ——— —_—- —_—— ee

31. If you are familiar with bearing terms (angular direction), try to estimate the number of degrees the object was
from true North and also the number of degrees it was upward from the horizon (elevation).

31.1 When it first appeared:

a. From true North _.________ degrees.
b. From horizon degrees.

31.2 When it disappeared:

a. From true North degrees.
b. From horizon ____. degrees.

Page 7

| 34. What were the we ther conditions at the time you saw the object?
34,1 CLOUDS (Circle One) 34.2 WIND (Circle One)

|

| * Clear sky a. No wind
eo b. Slight breeze

f ¢. Scattered clouds c. Strong wind

d. Thick or heavy clouds d. Don’t remember
e. Don’t remember

34.3 WEATHER (Circle One) 34.4 TEMPERATURE (Circle One)
71. = a. Cold

| b. Fog, mist, or light rain 22, Cool ss
c. Moderate orheavy rain ce, Warm

d. Snow d. Hot
e. Don't remember e. Don’t remember

[--

| 35. When did you report to some official that you had seen the object?
19 March 1953 |

ee ee Oe eee ee me + ~ - ——s

Day Month ~ Yeor

—— —— ae ee ee wes. me ee ee we we ome ee ee me ee ee lel —os -_—-—-<- _——- —--

_ =

-

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

; (Circle One) Yes No
| 36.1 IF you answered YES, did they see the object too?
: (Circle One) Yes No
36.2 Please list their names and addresses:
Fanily

37. Was this the first time that you had seen an object or objects like this?

(Circle One) Yes No:
37.1 IF you answered NO, then when, where, and under what circumstances did you see other ones?

—-

— ae

| 38. In your opinion what do you think the object was and what might have caused it?

| Ansared lite saucers from below,

Page 8

39, Do you think, you can estimate the speed of the object?
(Circle One) Yes No Slo: rate of ceed
IF you answered YES, then what speed would you estimate? o om YY

——— — —- —--— —- —

meee we

. 40, De you think you can estimate how for away from you the object was? Sthted obsect £ on Crystal

(Circle One) Yes No 35000 ft alt, Jake, Object wes over Medway aroa
traveling towerds Dayton,
IF you answered YES, then how far away would you say it was? ns _. feet.

—_ -_-- —_— -- —— - -- _ —

41, Please give the following information about yourself:

toa Name ' _ Name Middle Name ae,
pp, er Ry: CU ee?)

Street City Zone State

TELEPHONE NUMBER le ‘i

What is your present job? a wintinens -" ' eit seine badsiiakimcicnmsns

- Age ak Sex Male

Please indicate any special educational training that you have had. .

a. Grade school e.e. Technical school =
b. High school - (Type)
c. College f, Other special training orl

d. Post graduate - =

a —_—_-

19 March 1953
Day Month Year

42. Date you completed this questionnaire:

oe = a ee