PROJECT BLUE BOOK

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NEVER USE FOR APPROVALS, DISAPPROVALS.
CONCURRENCES, OR SIMILAR ACTIONS

INITIALS CIPCULATE

MEMO ROUTING SLIP

1 NAME OR TITLE
‘D-E (Attn: Major Friend)

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ORGANIZATION AND LOCATION

COORDINATION

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INFORMATION

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NECESSAR
ACTION

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NOTE AND

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Ridiosils

REMARKS

extracted from Capt Sell's Report

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a” 9 : ’ 3 . : ; , : .’*
reported UFO under observation. Form
attacned.

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FROM NAME of TITLE if DATE r=;
rp-X2 by ThHl 61

ORGANIZATION AND LOCATION

FORM Replaces DA AGO Form 895, 1 Apr 48, and AFHQ 48 —-16—74087-2
1 FEB 50 Form 12, 10 Nov 47, which may be used. oro

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U.S. AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire has been prepared so that you can give the U.S. Air Foree as much

information as possible concerning the unidentified aerial phenomenon that you have observed,
Plecs? 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 as 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 1s deemed necessary, we may contact you for
further details.

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]. When did you see the object? 2. Time of day: *. aks il,
| Hour Minutes
Xp ‘d ie Se | oy
Day Month Yoar (Circle One): A.M. or «P.M,
— ——= -—= —_-- — L — 3 ~ ——
3. Time Zone: | 1 asic
(Circle One): ag Eastern? (Circle One): a, Daylight Saving
Cc. Mountain
d. Preifie
e, Other
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MAG 7 fe { DUALS wn ASH 2
Netrest’Posta 7 City or Town * State or Country
Additional remarks: - - —-——--—-~
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5. How long was object in sight? x

Hours Minutes Seconds

5.1 How was time in sight determined?

c. Certain c. Not very sure
oy Fairly certain d. Just a guess

6. What wes “ne condition of the sky?

DAY NIGHT
a. Bright a. BrighP

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b, Cloudy b. Cloudy eS |

7, IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object?

(Circle One): a. Sn 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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AT! & FES 60 164 This form supersedes ATIC 164, 13 Oct 94,

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8. IF you saw the object ai NIGHT, what did you notice concerning rhe STARS and MOON?
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8.1 STARS (Cirele One): 8.2 MOON (Circle One):
a. None a Bright moonlight
b, A few b. Dull! moonlight
c. Many ¢. No moonlight — pitch dark
d. Don’t remember d. Don’t remember

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9. The object appeared:

(Circle One): 7s.) As a Night b. Shiny ¢. Dark d. Don’t romembar

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10. If it appeared as a light, was it brighter than the brightest:stars? =)

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11. Did the object:

(Circle One for each question)

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a. Appear to stand still at cny time? “Yes ) No Don’t Know
b, Suddenly speed up and rush away at any time? “Yes No Don't Know
¢. Sreak up into parts or explode? Yes No? Don’t Know
d. Give off smoke? Yes No? Don’t Know
e. Change brightness? a Yes) No Don’t Know
f, Change shape? Yes No Don't Know
g. Flash or flicker? CY¥es> No Don’t Know
h. Disappear.and reappecr ? Yes No) Don't Know

12. Did the object move behind something at any time, particularly a cloud?

(Circle One): Yes “No / Don't Know. IF you answered YES, then tell what
it moved behind: im as
13, Did the object move in front of something at any time, particulorly a cloud? |
(Circle One): Yes Nov Don’t Know. IF you answered YES, then tell whap
in front of: A aie = |
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14. Did the object appear: (Circle One): a. Solid b. Transparent c. Vapor d. Don't Know |
15. Did you observe the object through any of the following? :
ce, Eyeglasses Yes No ? e. Binoculars Yes No |
b. Sun glasses Yes No f. Telescope Yes No
c. Windshield Yes No g. Theedolite Yes No
d. Window glass Yes No SSS 2 ee 5 pend i ,
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16. Tell in a few words the following things about the object,

a. Sound

b. Color

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17. Drow a picture that will show the shape of the object or objects. Lebel.and include in your sketch any details

of the object.that you saw such as wings, protrusions, etc., and especially exhaust trails of vapor trails.
Place on crrow beside the drawing to show the direction. the object was.moving,

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18. The edges of the object were:

(Circle Ona): a. Fuzzy or blurred e. Other -

(>; Like a bright star

Draw a picture of how they were arranged, and put an arrow.to show. the direction that they were traveling.

¢. Sharply outlined Pree LAAT a a
d. Don’t remember
19, IF there was MORE THAN ONE object, then how many were there?
|

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

3, In the businass section of a city?

a. Inside a building b. In the residential section of a city?
b. Ina cor c. In open countryside?

“e.) Outdoors | d. Near an airfield?

‘d. In on cirplane (type) e. Flying over a city?

e. At sea f. Flying over open country?

f. Other Other

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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.) What direction were you moving? (Circle One)

c. 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 time while you were looking at the object?

(Circle One) Yes _ No
29. What direction were you looking when you first saw the object? (Circle One)
g. West
a. North c. East e. South h. Northwest
Cb) Northeast d. Southeast f. Southwest i, Overhead
30. What direction were you looking when you last saw the object? (Circle One)
g. West —
a. North c, East e. South h. Northwest
a
\b.) Northeast d, Southeast f. Southwest i. Overhead

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

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. ss degrees.

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