PROJECT BLUE BOOK

US PROJECT 10073 RECORD

1. DATE - TIME GROUP
or 4

OU 7

“a

He 710 Sitete

10. CONCLUSION INSUFFICIENT DATA FOR EVAIWATION

4. NUMBER OF OBJECTS

ll or 12
5. LENGTH OF OBSERVATION

seconds
6 TYPE OF OBSERVATION

ground visual
7. COURSE

no other information

i

11. BRIEF SUMMARY AND ANALYSIS

1l or 12 objects observed in SW moving to NE in seconds
observed by witness painting.

9% PHYSICAL EVIDENCE

© Yes
0D Ne

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

U. S$ AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire has been prepored so that you can give the U. S. Air Force os much
information as possible concerning the unidentified aeriol 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 os confidential material. Your name will not
be used in connection with any statements, 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.

]. When did you see the object? 2. Time of are OO a ~*~ :
i ." invies
a
ce (Circle One): — o P.M,

— —_-—-— = — ———

3. Time zone:
(Circle One): fez am) (Circle One): a. Daylight Seving
b. Cited bo Standerd>

c. Mountain
d. Pacific
e. Other

4

. Where were you when you saw the object?
sie \ \
est Pos ess City or Town “itt or Country

Additional remarks:

5. Estimate how long you sow the object. _.. -.
Hours Minutes Seconds

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

eo. Certain c. Not very sure
b. Foirly certain d. Just o quess

_-

_--— —

6. Whot was the condition of the sky?

a — 2 ewe me

(Circle One): a,‘ Bright do light d. Just a trace of daylight
b. Dull Jaylight e. No trace of daylight

c. Bright twilight f. Don’t remember
a 7. 1F ves saw the object during DAYLIGHT, TWILIGHT, or DAWN, where wos the SUN located os you looked ot
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

—o oe ee eee

Poge 3

16. Tell in o few words the following things about the object.

a. Sound
b. Color

17. Draw a picture that will show the shape of the object or objects. Label and include in your sketch any details
of the object that you saw such as wings, protrusions, etc., ond especially exhaust trails or vapor trails. Place
on 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 a tnliges
b. Like a bright stor
d. Don't remember

“>

19. IF there wos MORE THAN ONE object, then how mony were there?
Draw o picture of how they were orranged, and put an arrow to show the direction that they were trovel ing.

Page 5

—— TT eA

25. Where were you located when you saw the object? 26. Were you (Circle One)
(Cirele One):
6. Inthe business section of a city?
a. Inside a building cb In the residential section of a city?
b. Ina car c. In open countryside?
¢. Outdoor d. Flying near an airfield?
d, In aA Girplane e. Flying over c city?
e. At sea f, Flying over open country?

ee ee ee —_——- - aoe a ee  - |

4 ee e Ae eee Ree SR as |

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

re te
Sat i a0 eh Rd

ES OS Se

e-em ane

LS ———_ ELL te Ee te ee a Oo

-_—

—— + oe -

ee

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)

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

28.2 How fast were you moving? — omiles per hour,

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)

o. North c. East e. South g- West
b. Nerthoast d. Southeast CB) Southwest h. Northwest

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

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

31. If you are familiar with bearing terms (ongulor 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 ____._____._ degrees.
b. From horizon degrees.

31.2 When it disappeared:

oa. From true North
b. From horizon

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

In order that your information moy be filed ond coded as accurately as possible, please use
the following space 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 any further comments,
statements, or sketches thot you believe are important. Try to present the detoils of the observa-
tion in the order in which they occurred. Additional pages of the same size paper may be attached
if they ore needed.

tel

(Do Not Write in This Space)
CODE:

' SIGNATURE

DATE 2 > whyam_) be ee