PROJECT BLUE BOOK

1. DATE - TIME GROUP

. ,
2 duly 53 12/07252

4. NUMBER OF OBJECTS
Several
5. LENGTH OF OBSERVATION

ar 2 9A
j IAnutes

6. TYPE OF OBSERVATION ©

6. . re
2 BBs * ,_- >

wh

9. PHYSICAL EVIDENCE

O Ves

JLiNe
FORM

FTD sep 63 0-329 (TDE) Previous oditions of this form may be weed.

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( : / 4, 5" ' #

? | is wW Form A

\\ier MAY

U. 5. AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire hos been prepared so that you con give the U. S. Air Force as much
information os possible concerning the unidentified aerial phenomenon thot you have observed.

Pt»ase@ try to answer as mony questions os you possibly con. The information that you give will
be used for research purposes, and will be regarded a3 confidentiol material. Your name will nor

be used in connection with any stotements, conclusions, or publications without your permission.
We request this personal information so that, If it is deemed necessory, we may contact you for

further details,

Ove LAKME? 4

bla . a ve F { 7 . —

Series. TSH
1, When did you see the object? - 2. Time of day: .. > — <
al Hour Minutes
: y cfg | » te , “3 :
Day Month Yoer (Circie Gas): A.M or P.M, 5
ee _
3. Time zone:
(Circle One): o. Eastern (Circle One): o. Doylight Saving
b. Central b. Standard
c. Mountoin
d. Pacifie

e. Other — ¢ ‘ edaa al. f2 stad a «-* i

4, Where were you when you saw the object?

Adv ’ Sh Pe Seti
Nearest Postel Address City or Town State or Country

Additional remarks:

20

Estimate how long you sow the object. —
Hours Minutes Seconds

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

Certein ¢. Not? very sure
Fairly certain d. Just a guess

° avdTs

L/ae SA'9 - the. Pe:
woly Aravud Geta

6, Whet wes the condition of the sky?

(Cirele One): © Bright daylight d. Justo trace of daylight
Dull daylight e. No trace of daylight
c. Bright twilight f. Don't remember

7. IF you saw 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 loft
CBD In back of you e. Overhead
c. To your right f. Don't remember

—_ /_ ————————— —— =,
—_ a Cae ee ® ene ty ae ee e —

Page 2

8. IF you saw the ovject 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. Dull moonlight
c. Many c. No moonlight — pitch dark
d. Don't remomber d. Don't remember
9, Was the object brighter than the background of the sky?
SMALL“ OBSEETSE LAP LE Ib E
(Circle One): [irr (b) No . Don’t remember
ne PE ACh S58 EY oi ee

10, IF it was BRIGHTER THAN the sky islientall was the brightness like that of an automobile headlight?:
(Cirele One) o. A mile or more away (a distant car)?

(b,) Several blocks away?
ec. Ablock away?
d. Several yords away?
ei ES ee Sf en re
11, Did the object: (Circle One for each question)
a. Appear to stand still at any time? Yes (Na) Don't Know
b. Suddenly speed up and rush away ot any time? Yes CND Don’t Know
c. Break up inte ports or explode? Yes NS Don't Know
d. Give off smoke? Yes No Don't Know
e. Change brightness? Yes a Don't Know
f. Change shape? Yes Don't Know
g. Flicker, throb, or pulsote? Yes) No Don't Know
12. Did the object move behind something at anytime, particularly a cloud?
(Circle One): Yes (No) Don't Know. IF you answered YES, then tell whet
ree IS ES A ee
13. Did the object move in front of something at anytime, particularly a cloud?
(Cirele One): Yes) = No Don't Know. IF you answered YES, than tell what
it moved in front of: Sten: Masel Argun d aed fe Ffre
Ki fei? tae ine er .
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 (Ne) Ce, Binceulors 3%  CY¥es> No
b. Sun glasses Yes (No) f. Telescope Yes No

c. Windshield Yes LN g- Theodolite Yes No
d, Window glass Yes iN Hie: MINI cctninimnerininsipncetcenteinentbisesiniis

Page 4

ee ee ee

— - — —_———_—_- ee ee

20. Draw a picture that will show the motion that the, object or objects made. Ploce an “A® at the beginning

of the path, a “B’ at the end of the poth, and show any changes in direction during the course,
ah ges?

Lerge Cbd eat Sirgt) Pb /t, ye’ 3 north

a ‘ r : © A

~ ae | " a

— aw oO o t

i rig &
A- Lope? Lipaled Loree Ddb/eat /2 Senestoe siderte] oe ay er a ae
‘e) Large GbSee? faded at ot Sipee 4S Pimaled )
- ~ -

5: Stadioe DLbSoate faodeou pws oe Si» wd ee Prantl 2% *peve

21. IF POSSIBLE, try to guess or estimate what the real size of the object was in its longest dimension.
ideale ee ee feet. Larsen Oture } 4d ettrwnated foe 47 ae ‘@e pea?
ka imation siden? ¢ ee SS eS

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 .fmeesry Zeer g. Silver dollar

Cb.) Pea ferder Dhor h. Baseball
c. Dime i. Gropefruit
d. Nickel j. Basketball
e. Quortor k. Other
#, Holf 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 Foirly certain d, Uncertain

23. How did the chines or diet disoppear from oll sideptanl

ee tt ee —_——_ _—

—_——— - —_—-

24. In order that you con give as clear o picture os possible of what you saw, we would like for you to imagine thet you could
construct the object thot you sow. Of whot type material would you make it? How large would it be, and whet shape
would it have? Describe in your own words a tommon object of objects which when pleced up in the sky would give the

same appearance as the object which you sow. 6 eepae Shice?#? 2? Ah CPeude Shee ert berte ~

or Orv teder f Ban ~-“¢e Cavrteed ase fe Sunday /“2 yh e Sa ar: en ed -»
vin 0d, Simotiee Obdeols? Mighty Goheiee metetie Disag shoot Me
/

~“ Ye ef Lregec ~@/0e"°f,

Poge 5

25. Where were you located when you sow the object? 26. Were you (Circle One)

(Circle One):
a. Inside a building

a. In the business section of a city?
Cb) In the residential section of a city?

c. In open countryside?

b. Ina car
Outdoors d. Flying neer an airfield?
. Inan airplane e. Flying over a city?
e. At seo f. Flying over open country?
f, Other g- Other

27. What were you doing at the time you sew the object, and how did you happen to notice 11? Za as

rand 2he Bb door wait Cfearte VF 1bdbhls

xo > »

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

28.1 What direction were you moving? (Circle One)

o. North ce East e. South g- West
b. Northeast d. Southeast f. Southwest h. Northwest?

23.2 How fast were you moving? — oilers per hour,

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

29. What direction were you looking when you first sow the object? (Circle One)

a. North | Ce.) Eost e. South - g- West
b. Northeast? d. Southeest f. Southwest h. Northwest

30. What direction were you looking when you lest sew the object? (Circle One)

ce. North c. East e. South
b. Northeast d. Southeast §. Southwest

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

31.1 When it first oppeored:

a. From true North 5 degrees.
b. From horizon __.7" _ degrees.

31.2 When it disappeared:

@. From true Nerth __““—"_ degrees.
b. From herizon mr? a degrees.

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. Ploce a “B” on the some curved line to
show how high the object was above the horizon (skyline) when you Jost saw it.

33. In the following larger sketch ploce on “A” at the position the object was when you first sow It, ond a “B” at its
position when you last sew it. Refer to smaller sketch as an example of how to complete the larger sketch.

Peoge 7
34. Whot were the weather conditions at the time you saw the object?
34,1 CLOUDS (Circle One) 34,2 WIND (Circle One)
a. Clear sky a. No wind
b. Hazy (6, Slight breeze
(€) Scattered clouds ¢. 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)
Dry a. Cold
. Fog, mist, or light rein b. Cool
c. Moderate orheavy rain CE) Worm of”
d. Snow ) d. Hor
e. Don't remember e. Don't remember
35. When did you report to satin hes you had seen the object?
/ 2 vad ‘tee f oe Se
Day Yeoor _

o A __ —

36. Was anyone else with you at the time you sow the object?

(Circle One) (fos) No
36,1 IF you answered YES, did they see the object too?
(Circle One) (Yes) No

36.2 Please list their nomes and addresses:
firs | Sei? ena eee. ~~

I

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, ond under what circumstances did you see other ones?

/
38. In your opinion what de you think the object was and what might have caused it? / f.ee2 vo Hoses
fe Ae Cia he Th

or LoL y of anor ‘¢ Bad as '? é ve Laeet Lv ad all 6 4f 2 a aed,

Ftd fe eo - 4 ~ we = . 3 ’ ‘
Veo Veo+ “PS Me “vee. 00 -dpemtemsiedses, ‘hed Ce Atanged $5 @e Cwteveo ,
or vas hd Ae “the Seeee Lee Pee vrry Creel lewvwr - er Krone d “et ae dee ae
Sreened Ja fo! we «~ Verve @ee “Poseatew lad be. ad. le) Pore = . ;

, , ne a A ae ed se,

“eld det ave Crew VPM Foe fd,

Page 8
39. Do yow think you can estimate the speed of the object?
(Circle One) Yes Cc
IF you onswered YES, then what epued would you estimate? ee CT
40. Do you think you can estimate how far away from you the object was? ="
7 Pied Sigttesy ~ deve Pt Awig $00 2

eoeees =. -

(Circle One) (Yes) No Piss, th teced — ree *

IF you answered YES, then how welennadt 4/7 say, it was? an_peenemee
if ed fi “TF Wrst.

41, Please give the following information about yourself:

| y hori a + Ab ;
nee —— el Ol—e

TELEPHONE NUMBER —-—  _
a On ey) 7S

Age 2 - Sex a. 1

Please indicate any special educational training that you have hed.

a. Grade school _. == = ss—Ssé—éis co, -Trechniiccal school

i ete OS EE a

Sg Sak a 0, f. Othge epestal wotning Lae Zor ce Pierrery

Lnwd 10 @ “te 7 Se ee - .

d. Post graducte

42, Date you completed this questionnaire: f —{F— Lis “i 2 ev