PROJECT BLUE BOOK

1. DATE - TIME GROUP

be = rr , 29 oes
My wuly 53 4U,/0345

te

4. NUMBER OF OBJECTS

WO
5. LENGTH OF OBSERVATION

ibe
15 tainutes, still tn
6. TYPE OF OBSERVATION
SIO Wayle Tie
|

9. PHYSICAL EVIDENCE

FORM
FTD ser 63 0-329 (TDE)  provious editions of this form may be weed,

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U. S| AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire hos been prepered so that you can give the U. S$. Air Force as much
information os possible concerning the unidentified aerial phenomenon thot you hove observed.

Please try to answer os mony questions os you possibly con. The information that you give will

be used for reseorch purposes, and will be regerded as confidential material. Your name will not
be used in connection with any statements, conclusions, or publications without your permission.
We request this personal infermotion so thot, If it is deemed necessary, we may contact you for

further detoils,

1, When did you see the object?

—

/ me if > >
Day Month Yoor

3, Time zone:
(Circle One): ) ostern
Central
¢. Movuntein
d. Pacifie
e. Other

Neorest Poste seweee,
Additional remarks: wet ST

5. Estimote how long you sow the object.

2. Time of doy: O13 7 ~-
nutes

Hour
(Circle One): CAM or P.M,

— we

(Circle One): o. Daylight Seving
b.’Standord =o

5.1 Circle one of the following to indicete how certoin you ore of your answer to Question 5,

if 7 Certein
Fairly certain

6. What was the condition of the sky?

(Cirele One): a. Bright deylight
b. Dull daylight

c. Bright twilight

the object?

(Circle One): a, In front of you
b, In back of you

c. To your right

c. Not very sure
d. Just o guess

d. Justo trace of daylight
Ce. No trace of daylight
f. Don't remember

7. IF you saw the object during DAYLIGHT, TWILIGHT, or DAWN, where was the SUN located os you looked of

d. To your left
e. Overhead

f. Don't remember

Poge ?

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

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

9, Was the object brighter than the beckground of the sky?

(Circle One): (aN es b. No c. 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 cor)?
. Several blocks away?

c. A block away?
d. Several yords oway?
CR. SG Sa SO, | 2
11, Did the object: ~~ (Circle One for each question)
Appear to stand still at any time? Ves No Don’t Know
. Suddenly speed up ond rush away at any time? es No’ Don't Know
c. Break up inte ports or explode? Yes No’ Don't Know
d. Give off smoke? Yes No Don’t Know
fe Change brightness? Ye No Don't Know
f. Change shape? ° No” \ Don't Know-
-~ Os Flicker, throb, or pulsate? Wes No Don't Know
12. Did the object move behind something at anytime, porticulorly a cloud?
(Cirele One): Yes ( No / Don't Know. IF you answered YES, then tell whet
eee

ee ew ww eer ae

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

(Cirele One): Yes (Ne Don't Know. IF you enewered YES, then tell whet
RS ET ER IE EES rapa aC On ey aT a

-
—

=—_——_———s
Ya '

a

14, Did the object appear: (Circle One): a. Solid? b. Tronsporent? ( c. Don’t Know, —
15. Did you observe the object through ony of the following? Sage

a. Eyeglasses Yes No ed Binoculars (Yes No

b. Sun glasses Yes No f. Telescope Yes No

c. Windshield Yes No g- Theodolite Yes No

d. Window gless Yes No Se

(ee Nm ———ees—S—eSes—sSS Po io s

16. Tel! in @ few words the following things about the object.
0. Sound RoE shat Meme

7 y i . ” I
ad a “"*e :

b. ; . ; : Fl ; Pos J és ’

17. Draw @ picture that will show the shape of the object or objects. Lobel and inelude in your sketch ony detnils
of the object that you sew such os wings, protrusions, etc., ond especially exhaust trails or vapor trails. Place
en erow beside the drowing Yo show the dvecton the abject wes moving

18. The edges of the object were:

(Circle One): a. Fuzzy or blurred
Cb.) Like o bright? ster

c. Sharply outlined
d. Don't remember

19, WF there wes MORE THAN ONE chicst, then how many wove there? ee,

Drew o picture of how they were orrenged, and put an arrow to show the direction that they were travel ing,

SORA

*

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

| a. In the business section of a city?
Ce gd a building ) In the residential section of a city?
@ cor » In open countryside?
c. Outdoors d. Flying near an airfield?
d. Inan airplane e. Flying over a city?
f. Flying over open country?

ect, ond how did you happen to notice it?

Ze.

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)

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

miles per hour.

28.7 How fast were you moving?

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

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

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

30. Whet direction were you looking when you last sow the object? (Circle One)

a. North c./ East e. South g- West
b. Northeast . Southeost f. Southwest h. Northwest

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

31,1 When it first appeared:

o. From true North _____-____ degrees.

,

b. From horizon _._--____. degrees.

31.2 When it disappeared:

a. From true North _________. degrees.
b. From horizon ___.__._____ degrees.

Page 6

—_—_—

32. In the following sketch, imagine that you ore at the point shown, Place an “A” on the curved line to show how

high the object wos above the horizon (skyline) when you first saw it. Place a “B” on the same curved line to
show how high the object was obove the horizon (skyline) when you Jost saw it.

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

= — ov a a

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Poge 7

34. What were the weather conditions at the time you saw the object?

34,1 CLOUDS (Circle One) 34.2 WIND (Circle One)
Clear sky No wind
Hazy » Slight breeze
. Scattered clouds ¢. Strong wind
a. Thick or hecvy clouds d. Don't remember
e. Don’t remember
34,3 WEATHER (Circle One) 34.4 TEMPERATURE (Circle One)
Dry o. Cold
» Fog, mist, or light rain Cb) Cool
¢. Moderate orheavy rain > Warm
d. Snow d. Hot
e. Don't remember e. Don’t remember

35. When did cee / pleigee seen the object?

 -~- Ae

ee eee ee

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?
(Cirele One) Yes) No

36.2 Please list their names and addresses:

Vid —~ Sam ath 4-20-2_

37. Wes this the first time that you hed seen an object or objects like this?

(Circle One) No
37.1 IF you onswered ee ee rene een Senate nee

Se ———

38. In your opinion what do you think the object wos 8 ond what m . Zh * Sore, P ae
“Y ofa

ov

Poge 8
39. Do yow think you can estimote the speed of the object?
(Circle Onn) Yes : No»
IF you answered YES, then what ‘goed awd you estimote? Sncuiesiilientatiaiimioa, Tats

—

40. Do you think you can estimate how for away from you the object was?
"eal ~~
(Circle One) Yes / No
IF you onvwhed YES, then how for away would you say it was? a

information about yourself:

41, Please give the fol

; Sf }
Zone Stare
Whot is your present job? __- S na
/ #
Please indicate any epociol educational training that you have had. ees. { =
ae ie ‘ ; j . ; . f j ; ..”
oe. Grade school = si, ~Technicol school, ____ \.
b. High school ai ee (Type) “A of F odes "(£44 . : 1
@. College ath itr See f, Other ne weining 202 f
. 4! pf , / -
42, Date you completed this questionnaire: 5 = a. ;

a ht, a ln

Form 8B

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

In order that your information may be filed ond coded as accurately as possible, please use
the following spoce to write out a short description of the event thot you observed. You may re-
peat information that you have already given in the questionnaire, and add ony further comments,
statements, or sketches that you believe are importent. 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 atteched
If they ore needed.

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(Do Not Write in This Space)
aes CODE:

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SIGNATUREGZ

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