PROJECT BLUE BOOK

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

| In order that your information may be filed and coded as accurately as possible, please use

the following space to write out a short description of the event that you observed, You may re-
peat information that you have already given in the questionnaire, and add any further comments,
statements, or sketches that you believe are important. Try to presert the details of the observa-

tion in the order in which they occurred. Additional pages of the same size paper may be attached
if they are needed.

; NAME eee. (Co Not Write in This Space)
' se Print)

CODE:

SIGNATURE “i ; —

DATE _ a1 eS i a 2 a

Lipmrts fo tb wenfeedAd 9 aed

U. S. AIR FORCE TECHNICAL INFORMATION SHEET

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 thet you have observed.
Please try to answer os many questions as you possibly can. Tha informotion 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 necessary, we may contact you for

further details.

1, When did you see the object? .

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Doy Month Yeor (Circle One): A.M. or (Gy
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3, Time zone: ———~ ———
(Circle One): wax Eastern (Circle One): a. Daylight Seding
“b. Central b, Standard
c. Mountain
d. Pacific

4, Where were you when you saw the object?

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Nearest Postal Address City of Town State or Country

Additional remarks:

eo, Other :
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aS - 36 (Wh peep B* A Paap,

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5. Estimate how long you saw the object. f n> ee a
Hours Minutes Seconds y §

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

Q. Certain 7 c. Not very sure
b. “Fairly certain d. Justa guess

6. What was the condition of the sky?

(Circle One): a. Bright daylight d. Just.otrace-of-daylight ys
b, Dull daylight _e< No trace of deytight a chan
c. Bright twilight #. Don’t remamber

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
b, In back of you e. Overhead
c. To your right f, Don’t remember

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ATIC FORM NO, 164 (13 OCT 54)

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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 Ur jAcm
b. A fow 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?
a.

(Circle One): a, Yes b. No

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- Don't remember hot eta

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 car)?

b. Several blocks away?
c. Ablock away?

d. Several yards away?

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11, Did the object: >“*"™ I J al Pi cle 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 No Don’t Know
c. Break up into ports or explode? Yes No Don’t Know
d. Give off smoke? Yes No Don’t Know
e. Changs brightness? Yos> No Don’t Know
f. Change shape? Nex No Don’t Know
g- Flicker, throb, or pulsate? 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 whot
it moved behind:

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13, Did the object move in front of something at anytime, particularly a cloud?
(Circle One): Yes Gi? Don't Know. IF you answered YES, than tell what
it moved in front of:
| Wd, Did the object appeor: (Circle Ona): (7m. Solid? hb. Transparent? Se Don't Know,
15. Did you observe the object through any of the following? Ld
a. Eyeglasses Yes No (e/ Binoculars (Yes No
b. Sun glasses Yes No f. Telescope Yes No
c. Windshield Yes No g. Theodolite Yes No
d. Window glass Yes No h. Other ywahd a ns SO

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16. Tell in a fow words the following things about the object.

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b, Color _Obpcet sey Chana PLAS a te roof

17, Draw a picture thot will show the shaps of the object or objects. Lobel and Include in your sketch any details
of the object that you saw such as wings, protrusions, ete., and ospecially exhaust trails or vapor trails. Places
on arrow beside the drawing to show the diraction the objact was moving,

Lf 4°

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18 The edges of the object were: QD:
(Circle One): a. Fuzzy or blurred e. Other — r Ee Gita oth
b. Like a bright star '

c. Sharply outlined
d. Don't remamber -

—_——

19, IF there was MORE THAN ONE object, then how many were there? ‘

Drow o picture of how they were orranged, and put an arrow to show the direction that they were traveling.

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20. Drow a picture that 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.

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

22. How large did the object or objects appear as compored with one of the following objects. held in the hand
and at about orm’s length?
Silver dollor

(Circle One): a. Head of a pin g:

b. Pea h. Baseball
c, Dime i. Grapefruit
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 answer to Question 22.
a. Certain c. Not very sure
b, Fairly certain d, Uncertain

23, How did the object or objects disappear from view? A wer fe tae Cast, R
i srw Cun dv, ff 2a beer 25 yar

ot) 2

_

——

in order thot you con give as cleor o picture us possible of what you saw, we would like for you to Imaging that you could
construct the object that you sow. Of whot type moterial would you make It? How large would It be, and what shope
would It have? Describe In your own words o Eommon object or objects which when ploced up In the sky would give the

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same oppeorance as the objact which you sow,

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

(Circle One):

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a. In the business section of a city?

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

b. In a car >In open countryside?

(c,/ Outdoors d. Flying near an airfield?

t>—In an airplane e. Flying over a city?
e. At sea f. Flying over open country? | ways |
f. Other g. Other 1 beer oe RK

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

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? miles per hour.

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

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

| a. North Cc. Eést e. South co
b, Northeast d. Southeast f. Southwest . Northwest

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

a. North c. East e. South G wee?

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 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:

a. From true North degrees.
b. From horizon ______. degrees.

a Soe SS Se eee ee ee = So ee ee Se See 22 See nee ee

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34. What 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 b. Slight breeze
c. Scattered clouds c. 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)
a. Dry a. Cold
b. Fog, mist, or light rain b. Cool
c, Moderate orheavy rain c. Warm
d. Snow | d. Hot
e. Don't remember e. Don’t remember

35. When did you report to some official that you had seen the object?

Day Month Yoar
36. Was anyone else with you at the time you saw the object? ey ee, & pape
(Circle One) Yes No = 7S

36.1 IF you answered YES, did they see the object too? ; g- ga
(Circle One) Yes No fo

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) (Yes ” No

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

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

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Page 8
39. Do you think you can estimate the speed of the object? 4 - Us a Cyr x
(Circle One) Yes No ¢,
IF you answered YES, then what speed would you estimate? 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 far away would you say it was? feet.
*
41, Please give the following information about yourself:
st Name First Nome Middle Nome
aooress _ “=igiiiaiiaRgER> (Lid ley W Vr
Street City } Zone Stote
TELEPHONE NUMBER | GS
Whot is your present job? __
Age Sex . e
Please indicate any special educational training that you have had.
a, Grade school ©. @, Technical school
b. High school . (Type)
c, College f. Other special training
d. Post graduate
42. Date you completed this questionnaire: SEs Pre pe