PROJECT BLUE BOOK

5. LENGTH OF OBSERVATION
3 + & Seconds
6 TYPE OF OBSERVATION

Crewe ficou

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

U. &% AIR FORCE TECHNICAL INFORMATION SHEET

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This questionnaire has been prepared so that you can give the U. S. Air Force as much
information as possible concerning the unidentified aerial phenomenon that you hove observed.
Please try to answer a8 mony questions os you possibly can, The information that you give will
be used for resoarch purposes, and will be regarded as confidential material, Your name will nor
be used in connection with ony statements, conclusions, or publications without your permission.
We request this persona! 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: wh

, > a
y Menth Year (Circle One): A.M

3. Time xone:
(Circle One): 6 Eastern) (Circle One): ‘©. Daylight Saving
b. Central b, Standard

c. Mountain

d. Pacifie
e, Other

4, Where were you wher you saw the object?

“=  Neerest Povtel Address nap tiiuatea “State os Covnny
Additional romarka:
5. Estimate how long you sow the object, ant “ -
Hours Minutes Seconds

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

ce. Certoin c. Not very sure
cb. Fairly cortain > d. Justa guess
6. What was the condition of the sky?
(Circle One): a. Bright daylight d. Just a trace of daylight
b. Dull daylight. e. No trace of daylight
cc Beight twilight. > f. Don't remember

a

7, IF you sow 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
be* ln" back of you” e. Overhead
¢. To your right f. Don't remember

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ATIC FORM NO, 164 (13 OCT $4)

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

8.1 STARS (Circle Ono): 8.2 MOON (Circle One):
(None _/ | 6, Bright moonlight :
b, A few b. Dull moonlight
¢. Mony c. No moonlight — pitch dork

d. Don't rermomber d. Don't remember

mmm eee a eee -

b. No c. Don’ i remember

ee

(c ircle ° One): ag Yes )

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10, IF it wes BRIGHTER THAN the sky background, was the ivedennte like hat of an sutomobile headlight ?:

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

c. Ablock oway?

d. Several yards away?
o. Other Carr el 7 Ov Lio 1s

—_——_—-— ee ee ——_ eee

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11, Did the object: (Circle One for each question)
@. Appear to stand still at ony time? Yes No Don’t Know
b. Suddenly spoed up and rush away of ony time? Yes No Don’t Know
¢, Break up into parts or explode? Yes Nc Don't Know
d. Give off smoke? Yes No Don’t Know
e. Change brightness? Yes No Don’t Know
f. Chonge shape? ac. No- Don't Know
g. Flicker, throb, or pulsate? os No Don’t Know
12. Did the object move behind something at anytime, particularly a cloud?
(Circle One): Yes (Re) Den Know, Don't Know. IF you answered YES, then tell whet
it moved behind; _.._ EEE

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

(Circle One): Yes (ee) Don’t Know. IF you answered YES, than tell what
EE — ———————————————E—___—_———————————————E

— _ —_—_—_—_—

14, Did the objoct appear: (Circle One): G. “Solidg” b. Transparent? c. Don't Know.
15. Did you observe the object through any of the following?

a, Eyeglasses (Yes > No 0, Binoculors Yes No

b. Sun glasses ey No f, Telescope Yos No

¢, Windshield No g. Theodolite Yes No

d. Window glass Yos No h, Other — at EY =

Poge 3

16. Tell in @ few words the following things about the object.
page A, pe

\ ile e pitted -

17. Drow @ pleture thet will show the shape of the object or objects. Lobel ond inelude in your sketch ony detolls

of the object the? you saw such oe wings, protrusions, ete., ond especially exhaust traile or vaper traile. Place
on arrew beside the drawing to shew the direction the object wos moving.

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ey Gt le, VIG iv &
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18, The edges of the object were:
(Circle One): o. Fuzzy or blurred

b. Like Est stor

19, IF there wes MORE THAN ONE object, then how mony were there? en

Crew @ pleture of how they were orranged, and put an arrow te show the direction thet they were trevel ing.

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

a
22, How large did the object or objects oppear as compored with one of the following objects held in the hond
ond at about orm's length?
(Circle One): a. Head of a pin g- Silver doller
b. Pea h. Baseboll
ec, Dime §. Grapefruit
d. Nicket j. Bosketboll
e. Quarter k. Other
§. Holf doller
22.1 (Circle One of the following to indicate how certain you are of your answer to Question 22.

a. Certain
b. Foirly certain

23. How did the object or objects disappeor from view?

24, In order thet you con give os cleer « picture os possible of whet you sew, we would like fer you te imagine thet you could
conetruet the object the? you sow. Of whet type meteriel would you moke It? How lorge would It be, end whet shope
would it have? Deseribe in your own words o Lommeon objec! or objects which when pleced up in the sky would give the
seme oppeerance os the object which you sew.

Poge 5

25. Where were you lucated when you sow the object? 26. Were you (Circle One)
(Circle One):
a. In the business section of a city?
a. Inside a building b. In the residential section of a city?
b.~ Tha ca? c&_In open countrysi
ce Outdoors d. re) d?
d, In an airplane e. Flying over a city?
e. At seo f. Flying over open country?
f. Other g- Other

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 . Southeast f. Southwest h. Northwest
28.2 How fast were you moving? miles por hour.
28.3 Did you stop at any time while you were locking.¢¢ the object?
(Circle One) Yes c Ne ;

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

a. North “i ay e. South g- West
b. Northeast . Southeast f. Southwest h. Northwest

What direction were you looking when you last saw the object? (Circle One)

@. North GE Eon e. South g- West
b. Northeast? Southeast f. Southwest

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. e

7

a. From true North 42, degrees.

b. From horizon — “As” ees.

31.2 When it disappeared:

oO
a. From true North a: degrees.

b. From horizon 2.» " ” _ degrees.

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

high the object was above the horizon (skyline) when you first sew it. Place a “B” on the same curved line to |
show how high the object was above the horizon (skyline) when you last sew 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 o “B" at its
position when you last saw it. Refer to smaller sketch as an example of how to complete the larger sketch.

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ad Nip eile cy A me

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

34,1 CLOUDS (Circle One) 34.2 WIND (Circle One) |
e a

ti Sligh breeze
. Scattered clouds ona wind
4. Thick or heavy clouds é. Don't remember
e. Don't remember
34.3 WEATHER (Circle One) 34.4 TEMPERATURE (Circle One)
a.
b. One mist, or light rain ETosD
c. Moderate or heavy rain c.
d. Snow
e@. Don't remember |
35. When did you report to some official that you had seen the object?
Ss g-se Pet wie t & Ab ame
Dey Month Yeor
36. Wos anyone else with you at the time you saw the object?
‘es
(Circle One)\__Ye 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 an object or objects like this?

(Circle One) os No
37.1 IF you ons , then when, where, and under what circumstances did you see other ones?

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

: Page 8

39. Do you think you can estimate the speed of the object?

(Circle One) Yes ( Ne)
IF you answered YES, then what speed would you estimate? a LN

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

(Circle One) Yes No |
Sfurear trpeua yp J OSS + te / if? r> 3
IF you answered YES, then how fer away would you say it was? ee

41, Please give the following information obout yourself:

+ G o
00Ress a meme 7 GO
TELEPHONE NuMBER dasa

What is your present job?
Age Si Sex

Please indicate any special educational training that you heve had.

eo. Grode school _.. = = ss—S=7r.ej. Technical school
b. High sche! (Type)
oe ee
d. Post graduate .

42, Date you completed this questionnaire:

: aa let uit a ee