PROJECT BLUE BOOK

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LENGTH OF OBSERVATION
3@ Seconis
TYPE OF OBSERVATION

Mound-Visial

PHYSICAL EVIDENCE

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1}. BRIEF SUMMARY AND ANALYSIS

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

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Form B

U. S. AIR FORCE TECHNICAL INFORMATION SHEET
(SUMMARY DATA)

In order that your information may be filed and coded os accurately as possible, please use
the following spece to write oul a short description of the event that you observed. You moy re-
peat information that you have already given in the questionnaire, ond add any further comments,
statements, or sketches that you believe ore important. Try to present the details of the observa-
tion In the order in which they occurred. Additional pages of the same size paper may be attached

(Do Not Write in This Space)
CODE:

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U. & AIR FORCE vihanibin INFORMATION SHEET

This questionnaire has been prepared so that you can give the U. S. Air Force os much
information as possible concerning the unidentified aerial phenomenon that you hove 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 nor
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.

1. When did you see the object? 2. Time of day: / 37

y s Hour Minutes
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Day Month Year (Circle One): A.M, or (?™)
3. Time zone: i ]
(Circle Onehi(@ Eastern ) (Cirele One): a. Daylight Saving
. Central : (} Se
¢. Mountain oa
d. Pacific

e. Other dade

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4. saw the object?
Nearest Pos ddress City or Town State or Country

Additional remarks: OV «3yY Jess

——_ -—— -—_—_—_—_— _ ——— -_-— —

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5. Estimate how long you saw the object.

Hours Minutes

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

a. Certain c. Not very sure

¢ b. Fairly certain > d. Justa guess

—_—-— -_— = _—--,

6. What was the condition of the sky? Clicne w/7* SCP TITEREP CleyPDS

(Circle One): a. Bright daylight d, Just a trace of daylight
b, Dull daylight Ce. No trace of daylight»
c. Bright twilight f. Don't remember
7. 1F ‘ile eae the object during DAYLIGHT, TWILIGHT, or DAWN, where was the SUN located as you looked at
the object?
(Circle One): a. In front of you d. To your left

b. In back of you e. Overhead
c. To your right f. Don’t remember

———— e+-ee- — ——---

Page 2?

8. IF you sow 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):
a, None a* Bright moonlight *)
b. A few b. ull moon
€. Many ¢. No moonlight — pitch dark
d. Don't remember d. Don't remember

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

(Circle One): ( a 7) b. No c. Don’t remember

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

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

c. Ablock away?
d. Several yards away?

e. Other fro Lis Lope 77 <a S07) CP

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? Don't Know

f, Change shape? Don't Know

g. Flicker, throb, or r pulaate? Don't Know
12. Did the object’ move re behind something at anytime, particularly a cloud?

( Circle One): Yes (no) Don't Know. IF you answered YES, then tell what

it moved behind: we : ~~ asennaiiacinanaicionaas ——

—_ —-————- ——_—-—_—— - —-—-

—_--—— — —_— — ---_--- — ———— — =

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13. Did the object move in front of something at anytime, particularly a cloud?

(Circle One): Yes ("-) Don't Know. IF you answered YES, than tell what
it moved in front of: a wanted saa

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% Transparent?) c. _€+ Don’ t Know.

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—— —_-- — _

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14, Oi the object appeor: (Circle Sak & 4. Solid

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15. Did you observe the object through any of the following?

a. Eyeglasses Yes e, Binoculars Yes No
b, Sun glasses Yes f. Telescope Yes A
c. Windshield Yes / g. Theodolite Yes °
d. Window glass Yes o) h. Other - hee univilinanetiie

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16. Tell i @ few words the following things about the object.
a. Sound he Ss wefP

b. Color W/72 -
Fifptt.y ORANCE ~1779 PY eed

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

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

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18. The edges of the object were:

(Circle One): a. Fuz blurred e. Other _

Ch Like 0 bright ste ey sep aS
c. Sharply outlined ar. eee

d. Don’t remember — — —_—_——— —

19. IF there was MORE THAN ONE object, then how mony were there? Jp __ "EVs oe
Draw a picture of how they were arranged, and put an arrow to show the direction that they were travel ing.

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

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21. IF POSSIBLE, try to guess or estimate whot the real size of the object was in its longest dimension.
feet. IMPSS BIC Ze Cvess

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
» Pea ' h. Baseball
c. Dime 1. Grapefruit
d. Nickel j- Basketball
e. Quorter is CIRINO ccehieteesincancineenietneicen
f. Half dollar

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

ae c. Not very sure
. Fairly certain d. Uncertain

23, How did the object or objects disappear from view? — dvs7 wenz 0oVT  Lyyc ine
YRAINCH CF Lipy7 Bvth

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= —-— — ——

24. tn order thet you can give as clear o picture os possible of whet you sow, we would like for you to imagine that you could
construct the object thet you saw. Of what type moterial would you make it? How large would it be, and what shape
would it have? Describe in your own words a tommon object or objects which when ploced up in the sky would give the
some appearance as the object which you sow, _

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25. Where were you located when you saw the object? 26. Were you (Circle One)
(Circle One):
9. In the business section of a city?

. Inside a building db. In the residential section of o city? -’

b. Ina cor c. In open countryside?
4.5 “Outdoors > d. Flying near an airfield?

. In an airplane e. Flying over o city?
e. At sea f. Flying over open country?
§, Other g- Other

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

28. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the fallowing 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? —. ES soils per hour,

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

29. What direction were you looking when you first saw the object? (Circle One)
a. North c. East e. South GE West
b. Northeast d. Southeast f. Southwest - Northwest

30. Wheat direction were you looking when you last saw the object? (Circle One)

a. North ce. East e. South g. West
b. Northeast d. Southeast Cf. Southwest > h. Northwest

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 2). degrees.
b. From horizon. _& 0 __ degrees.

31.2 When it disappecred:

a. From true North 220 degrees.
b. From horizon __ 7 ___ degrees.

—_———_— —

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32. In the following sketch, imagine that you are 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” on the some curved line to
show how high the object was above the horizon (skyline) when you last saw it.

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33. In the following lorger sketch place an “A” at the position the object was when you first sow it, and a "B” at its
position when you last saw it. Refer to smaller sketch os an example of how to complete the larger sketch.

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34. What were the weather conditions at the time you saw the object?
a. Cleor sky a, No wind
b. Haz b. Slight breeze
attered clouds » _c, Strong wind
d. Thick or heavy clouds Cd. “Dont teneaber »
e, Don’t remember
34,3 WEATHER (Circle One) 34.4 TEMPERATURE (Circle One)
Ce. Dry > Cold
b. Fog, mist, or light rain x Coal
c. Moderate orheavy rain ¢. Wor
d. Snow d. “a
e. Don't remember e. ‘Dent remember
35. When did you report to some official i you hed’ seen the dint
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36. 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:

_ — _

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

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

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38. In your opinion what Pe you v think the idee was ee what might have caused it?
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39. Do you think you can estimate the speed of the object?

(Cirele One) (ww) No

IF you answered YES, then what speed would you estimote? / $°_— 200 mah.

40. Do you think you can estimate how far away from you the object wos?

(Circle One) Yes Ne >

IF you answered YES, then how far away would you say it was? a

41, Please give the following information about yourself:

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TELEPHONE ee
What is your present job? Peotéss PUP IW Ent-1a! EE 44
Age ei Sex KA L &

Please indicate any special educational training that you have had.

a. Grade school LS ts, e.@. Technical school Gfeed4yy Soty TECH%
5 oe (Type) Ark 0 f Liye Ent--
c. College Sheoneyn fly TECH ~~ f, Other special training
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42, Date you completed this questionnaire: Sa ——>=— > oT