PROJECT BLUE BOOK

1. DATE» THE GROUP

1 De 0130z

3. SOURCE

ivilian INSUFFICIENT DATA FOR EVALUATION
Jupiter 5h30 below horizon. Venus 15h23 and Mars 13h03 below
horizon.

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

15 mins’
6. TYPE OF OBSERVATION

Flashing: light, no sound, remaining in view for some time.

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9. PHYSICAL EVIDENCE Hi 9 oI
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FTD sep 63 0-329 (TDE) previous oditions of this form may be weed.

U. S| AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire hos been prepared so thet you can give the U. S. Air Force os much
information as possible concerning the unidentified aerial phenomenon that you have observed.
Please try to answer as many questions as you possibly can. The information that you give will
be used for reseorch purposes, and will be regarded as confidential moterial. Your nome will not
be used in connection with any statements, conclusions, or publications without your permission,
We request this personal information so thot, if it is deemed necessory, we may contact you for

further details.

1. When did you ove the ebjeu!? %, Time of dey: om» ¥
. ovr

— aon ene (Circle One): AM oc MW

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3. Time zone:

(Circle One): (a, Eastern (Circle One): a. Daylight Saving
b. Central b. Standerd
c. Mountain
d. Pacifie
e. Other a

4. Where were you when you saw the object?
- sd | = - ‘| . . » o "% = yi : . Now uy vv
Neorest Postal Address City of Town State or Country

Additionol remarks:

_——— _- —_—-_-- ooo:

—_ — a —_———— — —— —_—_—
5. Estimate how long you sow the object. —_ Ls. a
Y mt Hours Minutes Seconds

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. Just o quess
~~ What wos the condition of the sky? o - um Tr
cS
(Circle One): «a. Bright daylight d. Just o trace of daylight ©
b. Dull doylight e. No trace of daylight =
c. Bright twilight f, Don't remember y
———
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 left
b. In back of you e. Overheod
| c. To your right f, Don’t remember

‘
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( { Page 2?

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):
a. None a. Bright moonlight
b. A few b. Dull moonlight ,
e Mony (€. 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. Yes b. No c. Don't remember
10, IF it was BRIGHTER THAN the sky beckground, was the brightness like that of an automobile headlight?:
. eo ewes & (Circle One) a. A mile or more away (a distant cor)?
. Several block ?
: ¢. Ablock away?
d. Several yards away?
SOL Le iene =
11, Did the object: _. (Circle One for each question)
a. Appear to stand still at any time? (Yes: No Don’t Know
b. Suddenly speed up and rush away at any time? Yes (Noe Don’t Know
c. Break up into parts or explode? Yes No: Don't Know
d. Give off smoke? Yes No Don't Know
e. Change brightness? Yes No Don't Know
f. Change shape? Yes No Don't Know
g-. Flicker, throb, or pulsate? Yes No Don’t Know -
12. Did the object move behind something at anytime, particularly o cloud?
(Circle One): Yes (No _— Don’t Know. IF you answered YES, then tell whet
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13. Did the object move in front of something at anytime, particulerly a cloud?

(Cirele One): Yes Ne’, Don't Know, IF you answered YES, than tell what
ES
14, Did the object appeor: (Circle One): a. Solid? b. Transporent? c. Don't Know,

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

a. Eyeglasses Yes No e. Binoculars
b. Sun glasses Yes No f. Telescope

c. Windshield Yes No g- Theodolite
d. Window glass Yes h. Other

16. Tell in @ few words the following things about the object.
a. eS Oo
b. Coler \ : by a +} \ x

’ > “ ,
* . .

Sis a.

— o—-

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

(Circle One): a. Fuzzy or blurred e. Other _
@) Like a bright stor
¢. Sharply outlined
d, Don’t remember —_—

19. IF there was MORE THAN ONE object, then how many were there? 2
Drow o picture of how they were arranged, and put an arrow to show the direction that they were travel ing.

— we +e re oe

Poge 4

20. Draw a picture thot 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 any changes In direction during the course.

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

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

(Circle One): a. Head of a pin g- Silver dollar

b. Pea h. Baseball

d. Nickel j. Basketball

@. Quarter k. Other

f. Half dollar

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

a. Certain c. Not very sure

ib. Fairly certain d, Uncertain

23, How did the object or objects disappear from view? — 5s

s * . _ ‘ 4 »

24. In order that yeu con give as cleer a picture as possible of what you sew, we would like for you te imagine thet you could
construct the object thet you sew. Of whet type meterial would you meke it? How large would it be, ond whet shope
would it heve? Describe in your own words « Lommon object of objects which when placed up in the sky would give the

seme oppeerence os the object which you sew,

Poge 5

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

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

C —— @ cor 4. In open countryside?
d, Flying near on airfield?

‘e. ) Outdoor

: In an deabinis e. Flying over a city?

e. At sea f. Flying over open country?
Se RN veecnnreneentecremrsteeetemnententesceneentemmnennnee’ g- Other

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

XY is m. s eS. \

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

28.1 What direction were you moving? (Circle One)

e. North CY Eost 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 ot any time while you were looking ot the object?

(Circle One) { Yes) No
29. What direction were you looking when you first saw the object? (Circle One)
a. North GY East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest

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

@. North @ East e. South g- West -
b. Northeast d. Southeast 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:

a. From true North
b. From horizon

31.2 When it diseppeared:

a. From true Nor th
b. From horizon

Poge 7

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

34,1 CLOUDS (Circle One) 34,2 WIND (Circle One)
a. Clear sky a. No wind
b. Hazy b. 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)
o. Dry @. Cold
b. Fog, mist, or light rain b, Cool
c. Moderate orheavy rain ¢. Warm
d. Snow d. Hot
e. wea t romania e. Don't remember
35. When did you report te some official that you hed ani object?
—t—__ — Laas eis a he
Yeor

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

(Circle One) (Yes No
36.1 IF you answered YES, did they see a object too?
(Circle One) . Yes.

36.2 vane . aa ‘ .

—_———_— —_ -_ —_— a a ee

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

(Circle One) (wes No

37.1 IF you answered NO, then when, where, and under what circumstances did you see other ones?

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38. In your opinion as do you think the object was ond whet might hove caused it?

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

Poge 8

(Circle One) Yes No
IF you answered YES, then whot speed would you estimate? obeabant” __.. m™p.h,
40. Do you think you can estimate how far away from you the object was?
(Circle One) Yes No
IF you answered YES, then how for away would you say it was? ee
41, Please give the fol
NAME __
$s Ls \ eee ae he awe
City Zone Stote
TELEPHONE =, ;
What is your present job? CE REE 2.) TENT CP oh de
a Sex a

Please indicate any special educational training that you have had.

a. Grade school _. ss t—t—és tw. @,- Technical school

ae TPIT inicdeibnaiiietiumpesinunnenaetinnniiamesinimenstssabeibibatinien
a ee oe f. Other special training .
d. Post graduate

42, Date you completed this questionnaire: = —-—— Foes