PROJECT BLUE BOOK

Pegs 7

——$

— - — -_—-

34, What were the weather conditions at the time you saw the object?
CLOUDS (Circle One) WEATHER (Circle One)
; }
a. Cleor sky a. Dry
i b. Hazy b. Fog, mist, or light rain
- €. Scattered clouds ) c. Moderate or heavy rain
d. Thick or heavy clouds d. Snow
‘e. Don't remember
!
| 35. When and to whom did you report that you had seen the object? LPigel wi
fet ) < iL
oT. a MPC Ae > 2 /
“Dey Month Yoor
36. Was anyone else with you at the time you saw the object?
a —
(Cire! One) (Yes hes
>,
36.1 IF you answered YES, did they see the object too?
. ie ;
(Circle One) ( Yes’ No
36.2 Please list their n occresses:
—_ 2. —_*
Sei a CCF te
37. Wos this the first time that you had seen an object or objects like this?
(Circle One) ‘Yos’ No
| xe
37.1 !F you enswered NO, then when, where, and under what circumstances did you see other ones?
23, In your opinion whet do you think the object was and what might have caused it?
‘SL omdt fsttt~ ¢fo7 the COfCG Atl, £. c Aon Fons =
k , 3 vé , “4 , Ae ‘ wy . wa Jf » oten ~ ’ : r :
~gt" « y = i? }
74 F , / 3 we i
|

Poge 8

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

-_—,

(Circle One) (Yes No

IF you answered YES, then what speed would you estimate? << o

40, Do you think you can estimate how for away from you the object was?

(Circle One) (Yor No

lF you cnswered YES, then how far away would you say it was? LEO

41, Please give the following information. about yourself:

tei “Cast Nome pal 5 ee
eee gas: AVE L. +7 Fe ENMIE C444,
ADDRES =e irmet : City Zone State .

_—

TELEPHONS NUMBER__ AVE NE

*

Indicate cny additional information cbout yourself, including any education, which might: be pertinent.

i? , 7 4 ,
j y . . is -, s* / ae
Yt~ Asad « pti frord on UEC.
7
{/ eee tl or Pee , == , : . : >
> , i ae _ C - ie C 4 LatOn Leal a2 pot tel MER “ thy Lee Ze d fi Ad 1 uo
—_ 2

— , > *
Aa otc = J ata ‘a righ a
7

< es ‘ a oe
y, ‘Vf "AIL. 67
‘Day Month Yoor

42. Date you comeleted this questionnaire:

U.S. AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire has been prepured so that you can give the U.S. Air Force as 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 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 is deemed necessary, we may contact you for
further cerails.

en poms or sets ee es Soto ee es ere en
]. When did you see the object? 2. Time of day: 2 eee 2 _« =
Hour Minutes
‘ ; ” i \
= 5 oe =~) als > Cj j A ™~ ,
Day Month Yoar ( ircle One): A.M, or P.M.

3. Time Zone:

(Circle One}: a. Eastern (Circle One): a. Daylight Saving
b. Centrcl _b. Standard ,
c. Mountsin : ——,
d,_Pocitid |
e. Otner =f
4. Where ware you when you saw the object? jg: Os
C) rin 7 J - ' m~ (
i Neorest Postal Address City or Town Stets of Country
Additional remarks: mone
or rc =
5. How long wes object in sight? i i i
Hours Minutes Seconds

5.1 How was time in sight determined?

Certain c.’ Not very sure)

ty, Foirly certain d. Just o guess

6. Whot was the condition of the sky?

DAY NIGHT
a, Bright a. Bright
b. Cloudy b. “Cloudy) i
Rin <ait a ae — ‘

7. IF you saw the object during DAYLIGHT, where wes 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

FORM
FTD JUL 41 146 4 Thin form oi pera «dee ATIC 164, } eh 60, which ta obwolete,

Page 2

———— ee we eee ee

8. IF you sow the object.ct NIGHT, what did you notice concerning the STARS and MOON?

8.1 STAR) (Circle One): 8.2 MOON (Cire!ls Ona):
a, None a,” Bright moonlight
b. A fow) b. Dullimoonlight |
c. Many c. No moonlight — pitch dark |
d. Don't remember d. Don’t remember

9. The object appeared:

4 ~~, |
(Circle One): o. Asa light | b. Shiny c. Dark d, Don’t remember |
= Se ad
om
10. tf it oppecred as a light, wos it brighter than the brightest ators? = | *
1}. Did the object: (Circle One for each question)
c. Apoecr to stand still ct ony time? (Yes) No Don't Know
b, Sucdeniy speed up ond rush sway at any time? Yos (Nod Don’t Know
c. reek up into ports or explode? Yes ie) Don’? Know
d, Give st? smoke? Yes Nol Don’t Know
i 9. Cherge brightness? Yos (No) Don’t Know
f, Chance shope? Yos (No: Don’t Know
g. Flesh or flickor? Yes (No Don't Know
h. Disepoear ond reappear 7 Yos No! Don’t Know

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

_ J j

(Cirele One) Yes, No. Don't Know. IF you answered YES, then toll what
It moved Senind: -\ “Tg ew “A . wie Per

,

—— —

13, Did the object move In front of something at any time, particularly a cloud?

(Circle One): Yes (No Don’? Know. IF you onawersd YES, then tell what
in front ot:

—_—=-

— -- . —_—: —

a —— -- —— - —_—----—----— —— —— —

14. Did the object oppecr: (Circle One): a Goltd’ b. Transparent c. Vapor d. Don’? Know

ee

—— + ee ae —-——_— ee ee

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

_— —s

a, Eyeglasses Yos (No) e, Binoculars Yos (Na)

b, Sun glasses Yos No! i. Telescope Yes iNol

c. Windshield Yes No ». Theodtolirs Yos ‘No
Pa ~. oe

d Window 3! 3% Yos No! hy, Orber ,

me ew ee qe wer en ee

|
2
|

— -_ es ee - —-+-+@ - eee

i
}

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

-
|

™ - +f > - ,
i. a ~ : at

0, Sound = as : ; ‘ ¥ : . ae

,

—
an ~—

b. Color = CAN FO TY, .

17. Draw a picture that will show the shape of the object or objects. Label.and include in your sketch any details
of the oblect that you saw such as wings, protrusions, etc., and especially exhaust trails or vopor trails,
Place an crrow beside. the drawing to show the direction the object was. moving.

' POP tne :
— * --<

~ ; ° af ' ‘
, a \ ' +
. = ;
oe . -
ry
™ ~
>
- - &
. ¢ ;
’ — 6
*% 4 j
, 7
~
j
~~, a
=~ U =
‘e |
~ +
= ge — ee ee
S eee
we ie oo rer
;

18, The edges of the object. wera:

(Circle One): a, Fussy or biurred eo, Other
(b) Like.a bright stor
(€)) Sharply outlined

- d, Don't remember

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

eel ---—- = ——=

Draw o pieturs of how they were crranged, and put on arrow to show the direction that they wars traveling.

Page 4

20. Draw a picture that will show the motion that the object or objects made, Place an ‘‘A” at the baginning of
the path, a ''B’’ at the end of the path, and show any chonges in direction during the course.

21. How large did the object appear to you cs compared to an object with which you ore familiar?

Me j i , : °
* f21) £ Zz ; Le} Ca rw ef i, ws +
—_

i ll e
$$ ——_ —— —- oo —_— _ — —_—-- as!

22. Yio wish to know the enguler size.- Hold: match stick at arm's length in line with a known object.and note
how much of the object-is covered by the head of the match. If you had performed this oxperiment? ot ths time
of the sighting, how much of the object would have been covered by the match head?

{F CG “

y ‘

23, Did the object disappear while you were watching It? If 20, how?

24. In order thet you can give as clear a pictures as possible of what you saw, descrize in your own words a

common object or objects which, when ploced up in the sky, would give the same appeoronce as the object
which you sew,

|
|
|

Page 5

—

_—- —s —

—<§£$ LO ee

25. Where wers you located when you sow the object? 26. Were you (Circle One)
(Circle One): .
a. In the business section ofa city?
a. Inside a building ‘b. In the residential section of a city? )
b. In a car c. In open countryside? ~
Cc. “Qurdeors) d. Neor an airfield?
d. in cn cirplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. Other g- Other. - i aie
28. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions:
28.1 “hat direction were you moving? (Circle One)
e. North c. East e. South q. West
>. Northeast d. Southeast f. Southwest h. Northwesr
23.2 How fast were you moving ?_ miles per hour,
23.3 22 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
o. North c. East e. South’ ) h. Northwest
es (ortRaost) d. Southeast f, Southwest i. Overhead
30. Whot direction were you looking when you last saw the object? (Circle One)
5. West
o. North c. East e. South h. Northwest
b..Northecs>, d, Southeast f. Southwest i. Overhead
31. If you are ‘omi.icr with bearing terms {angular direction), try to estimate the number of degrees the object was
from true Norn (thruv east) and clso 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 doqrees.
31.2 When It disappeared:

a. From true North degrees,

b. From horizon_ __ degrees.

|

nL at CC OL LL LLL LL LL ALLL LL LLL LLL LLL LLL ALLEL LOLA LLL LLL LEO LL ALLL LLL LLL LLL LALLA LALA =
-

Poge 6

a — ~

32. In the following sketch, imagine that you are at the point shown. Place an “A” on the curved line to show how
high the object was above the horizon (skyline) when you first saw it. Place a “B” on the same curved line to
show how high the object was above the horizon (skyline) when you lost sew it.

33. In the following larger sketch place cn “A” at the position the object was when you first sow it, and a “B” at its
position ween you last saw it, Refer to smaller sketch as an example of how to complete the larger sketch.

Pege 7

- ~—_-— + —

——_—_

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

CLOUDS (Circle One) WEATHER (Circle One)
|
o. Clear sky a. Dry
b. Hazy b. Fog, mist, or light rain
Scattered clouds, c. Moderate or heavy rain
i d. Thick or heavy clouds d. Snow
e. Don’t remember
. . — _.
35. When and to whom did you report thet you had seen the object?
- “ “ - ' ’ .
“a Day = Month Yeor
!
|
36. Was anyone sise with you at the time you saw the object?
(Circle One) \ Yes No
>.
36.1 IF you answered YES, did they see the object too?

~

(Circie One) "Yes No

ee ll

Pleose ‘ist their names and oddresses:

~
_-

37. Was this the first time that you hed seen an object or objects like this?
; (Cire! One) (Yes: No

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

; —— —

;
7 |

38. In your opinion wnat do you think the object was and whot might have coused It?
}

.
» 4. ; . F.

Page 3

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

~sy

(Circle One) (Yes! No

IF you answered YES, then what speed would you estimate?

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

(Circie One) (os No

* _ foe

, ’ i

IF you answered YES, then how far away would you say it was?! | Whi cet

41, Please give |

information.about yourself:
st Name i. a.
\
= ws J am:
ADDRES . City Zone State

TELEPHONE NUMBER_“\_-

_
—

Age - Sex; !

~
— — _

Indicate ony additional information cbout yourself, including ony education, which might:be pertinent.

be
|
|

|

ES pe ee es: aL
42. Date you completed this questionnaire: laa mee - | {*} he
Day Montn Yoor

—

ln 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 present 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 ore needed,

U.S. AIR FORCE

Page 3

TECHNICAL INFORMATION SHE2T
(SUMMARY DATA)

(Do Not Writs in This Space)

CODE:
7 rs |
—— al : :
DATE _ ae
¥
. _— +. —
| ANA. Kf Cres I
E> a 4 | o ’ ad - +
\e . ’
as 7
> / 7]
i _/ / ‘ d* . Foaati ot
. U Np
Vv
&, si
s j 2
|
}
|
—E —— —~ eta —

U.S. AIR FORCE TECHNICAL

INFORMATION SHEET

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

informotion as possible concerning the unidentified aerial phenomenon that you have observed.

Please try to onswer 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.

ee

ee ee ee

ee ee ee

——<——S as ee ee tS

1]
‘|
!

=
‘

OD _ : Pa <<.

6. What was tne condition of the sky?

DAY NIGHT
a. Bright a. Bright
b. Cloudy cb. Cloudy>

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

1. When did you see the object? 2. Time of day:
4 Hour Minutes
G 5 Os -
See: ae. 7 ph Tied —, *
Da Month Yoor (Circle One): CAM.) or P.M.
= alte
3. Time Zone:
(Circle One): a. Eastern (Circle One): a, Daylight Saving
b. Centro! CBD Standard
c. Mountain
d. Pacitia
e. Other
4, Where were you when you saw the odiect?
rhe ae '
reas (_-Af f4 i AIIE IR. 2. (4. Cette i )|
= Necrest Postal Address City or Town State or Country
Additional remarks: -
5. How long wes object in sight? -~ - 2 : —_
Hours Minutes Seconds
5.1 How was time in sight determined? (/2le4 on, - mA LY tated ttt PON atte A rif
CrPPSiD Site, S410 BreaacesrT)
a. Certain {c. Not very sure
b. Fairly certain d, Jus¥o guess
|

“as

(Circle One}: a. In front of you d. To your left
b. In back of you e. Overhend
c, To your right f. Don’t remember
FORM 3
F i D tit 61 14 4 ‘Thinform superucdes ATIC 164, Feb 60, which In obsolete,

Page:

8, IF you saw the object at NIGHT, what did you notice concerning the STARS end MOON?

8.) STARS (Circle One):

8.2 MOON (Circle Ona):

|

a. None Ca. Bright moonlight )
qb. A fow ) b. Dull moonlight
c. Many c. No moonlight — pitch dork
d. Don’t remember d. Don’t remember
;
9. The object copecred:
ae ee”
(Circle One): Co. As a light ) b. Shiny ce. Dark d, Don't remember
| 10. If it eppecrsd as a light, was it brighter than the brightest:stors? = VC

TT:

li. Did the object:

(Circle One for each question)

— — ne | See EEE Hee ee ee

3. Appecr to stand still ot any time? (Yos a No Don't Know
b. Suddenly speed up ond rush cwsy at any time? Yos. (No» Don't Know
¢. Breese up into parts of explode? Yes CN > Don't Know
4, Give of? smoke? Yos (No) Don't Know
», Cheese brightness? Yos (No) Don’t Know
f, Chance shape? Yos (No ) Don’t Know
g. Flosn or Flicker? You Gey Don't Know
h, Diseopecr end reappear 7 You (No) Don't Know

12. Did the object move behind someting at any time, particularly o cloud?

d.

I ae -— ~-a |
{Clrele Cre): Yos (No) Don't Know. IF you answered YES, then pall what
lt moved >ehing: ‘et —_ ——s
————— '
—E — — meee — —- ee
13, Did the obdjeer move In front of something at any time, particulerly.a cloud?
= me,’ = 4
(Cirele One): Yes (No) Don’t Know. IF you onawered YES, then tell whor
In front >t: = sea |
f « ee > b. T Vape d. Don’t Kno
14. Did the object appear: (Circle One): (a, Solid) b, Transparent  c. Vapor - hrc!
15, Did you observe the object through any of the following? |
-- ‘ . (7 5 sy -
@, Cyegiosses Yos (No e, Olnoculars fos (No,
“ . “om . - , “A sh ‘
b, Sun glasses fez (No) i. Telescane ion Ng i
Ce Windshie='d y : (} 1h? ilolite Y tu N o ‘

Window 1

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ee ee ee

Tt

por

Page 3

16. Tell in a few words the following things about the object,

rT

. Sos =e . j 2 > , AT -
a, Sound LEE Sho iL 22S Ceti TE S74 422 > A) WZ? {39S SS ay TAAL SE

af 2 - ry fe s we > my ’ | - ;
b. Color 440 Cos of oi Ps 2A SEAL cat Bp Ber LG Hts 2a oF Br
La2 EMS tla tctl eel 0 Wr oa \s a AoE» Oe 2 — Ma Ee E24 ols

17. Draw a pictures that will show the shape of the object or objects. Label.and include in your sketch eny details |
of the object that you saw such as wings, protrusions, etc., and especially exhaust trails or vepor trails. |
Place on crrow beside.the drawing to show the direction the object was.moving.

oe — -_—-—_—s

18. The odges of the object were:

(Circle One): a. Fuzzy of Sivrred e. Other 2 Ae
b, Like a bright stor = xz Chad
c. Sharply outlined
: d. Don't remember

a _ _- —_—

— -_—_—

19. IF there wos MORE THAN ONE object, then how many were thers?
Draw a picture of how they were crranged, and put an crrow to show the direction that they were traveling.

Poge 4

- ee —_—_ ——_ _-_

eee

20. Draw a picture that will show the motion that the object or objects made. Place an “A” at the beginning of |

the poth,:a ‘"B’’ at the end of the path, and show any changes in direction during the course. j

How large did the object appear to you as compared to an object with which you ars familiar?

-

We wish to know the angular size. Hold.a match stick at arm's length in line with a known object.and nots
how much of the object-is covered by the head of the match. If you had performed this experiment at the time
of the signting, how much of the objact would have been covered by the match head?

23, Did the obieet disappecr: while you were watching It? If a0, how?

i 3

24. In order the? you can give as clecr a picture os possible of what you sow, describe in your own words a

common object or objects which, when ploced up In the sky, would give the sams oppeorance as the object
which you sew,

Page 5

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

(Circle One): |
a. In the business section of.a city? '

a, Inside a building Cb. In the residential section of a city? >

b. Ina cor “G. In open countryside? ij

‘s Outdoors d. Near an airfield?

d. In an cirplone (type) e. Flying over a city?

e. At sea f, Flying over open country? |

f, Other g- Other._

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

ee ae ee ee we

ee

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

28.1 Whet direction were you moving? (Circle One)

c. North c. East ce. South g- West
| b. Northeast d. Southeast f. Southwest h. Northwest

23.2 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
c. North c. East Ce South ) h. Northwest
b. Northeast d. Southeast f, Southwest i. Overhead
30. What direction were you looking when you lost saw the object? (Circle One)
g. West
co. North c. East e. South h. Northwest
(b. Northeesr. d. Southeast f. Southwest i. Overhead
| 31. If you are fomiiicr with beoring terms (anguler direction), try to estimate the number of degrees the object was

from true Norts (thru east) 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 dogroes.

31.2 Whon |t disappeored:

go. From true North degrees.

- ———
——— oe +o

b, From horizon ie _deorees.

Page 6

32. In the following sketch, imagine that you are at the point shown. Place an “A” on the curved line to show how
high the object wos above the horizon (skyline) when you first saw it. Place a “B” on the same curved line to
show how high the object was above the horizon (skyline) when you lust saw it.

pasition wen you last saw it. Refer to smaller sketch as an example of how to complete the larger sketch.

’
oe
OE Rte ber get
TS Orr. cme :

—————

Pegs 7

-—— ————__—_ - —-~ —~—-- oe —

34, What were the weather conditions at the time you saw the object?

CLOUDS (Circle One) WEATHER (Circle One)
a. Clear sky (a. Dry )
& Hozy b. Fog, mist, or light rain
C8 Scattersd clouds ) c. Moderate or heavy rain
d. Thick or heavy clouds d. Snow
e. Don't remember

35. When and to whom did you report that you had seen the object?

Dey Month Your

36. Was anyone else with you at the time you saw the object?

PBN
(Circ'e One) (Yes, No

eee

36.1 IF you answered YES, did they see the object too?

(Ciecle One) (Yes) No

Ei

346.2 Please list their names end “al

——— — —

| 37. Was this the first time that you hod seen an object or objects like this?
(Circis One) (Yes } No

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

a eee ee eee OO OS OO eee

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

Page 6

2h SS vere .

32. In the following sketch, imagine that you are at the point shown. Place an “A” on tha curved line to show how
high the object was above the horizon (skyline) when you first saw it. Place a “B” on the same curved line to
show how high the object was above the horizon (skyline) when you last saw it,

33. In the following larger sketch place on “A” at the position the object was when you first saw it, and a “3” at its
position when you last saw it, Refer to smaller sketch as an example of how to complete the larger sketch.

Page 5

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

(Circle One):
g, In the business section of a city?
a. Inside o building (b. In the residential section 1 of a city?»
b. Ina cor e. In open .countryside?
«é Outdoors ; d. Near an airfield?
d. In an airplone (type) e. Flying over a city?
e. At see f, Flying over open country?
: f. Other =|. ere g- Other a

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

-~ . a - ——-s

28. IF you were MOVING lit AN AUTOMOBILE or other vehicle at the time, then complete the following questions:
28.1 Wheat direction were you moving? (Circle One)

c. North ce. East e. South g- Wost
b. Northeast d. Southeast f, Southwest h. Northwest
28.2 How fost 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)
we g. West
a. North c. Eost Ce. South h. Northwest
b. Northeast d. Southeast f. Southwest i. Overhead

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

West
G. North = c. Ecst e. South h. Northwest
Cb. Northecsr d. Southeast f. Southwest i. Overhead

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

21.1 When it first eppecrad:

wm mm
Lo]
>

a, From true North _— degrees.

b, From horizon degroes.

31.2 Whan it disappeared:

a. From true North degrees.

woe ee ae oe ree

b. From horizon degrees.

Poge 0

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

a

(Circle One) (Yes No |

IF you answered YES, then whot speed would you estimate?

= —— —

40. Do you think you can estimate how for away from you the object was?

(Circie One) Yes No
IF you answered YES, then how for away would you say it was?

41, Please give the following information about yourself:

as ome

| mee Af. } , P f
ADDRESS : fp — ~* - ~
City Zone Stots
/ AS,
Age_/ + Sex __ 7’
| Indicate ony additional information c>out yourself, including any education, which might:be pertinent.
~~ ~——— . ae A
> A DRI aoe ClO. erry oriacy gash
- s Pd ft Lf a - ao. ar A . “; <—S . : J 4 ‘ fA 4
¢ a «te e ° & a git é . - {/ vad 7 A
)
| fs i , Cc ; ? 2
é 4 DLetmne ¢_ Sea Sot. . oe j pe ae Oe
42. Date you complered this questionnaire: : EL If . z
Day Month Yoor

-_——_

-

—

‘

!

|
f

}

4

} , Page 9

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 thot you have already given in the questionnaire, and add any further comments,
statements, or sketches thot you believe are important. Try to present 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 ore needed. |

NAME OIE (Do Not Write in This Space)
| Please CODE:

—— J? : a“ mr = 4G 4 72
DATE OAL. —_

-—————

——_ — ————_ ---—-

U.S. AIR FORCE TECHNICAL INFORMATION SHEET

This questionnaire has been prepared so thar you can give the U.S. Air Force as 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

2 used ‘or research purposes, and will be regarded as confidential material. Your name will vot
be usec 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.

* . ‘ r
When did you see the object? 2. Time of day; f an > xO :
_ , Hour Minutes
2 EL ~~
——-—- --—-- mr peer? vr . Sn), Se (Circle One): é 4 A
Doy Month Yeor ce Vne;: ( ME or ofthe
ge
3. Time Zone: -
(Circle One): a. Eastern (Circle One): o, Daylight Saving
b. Central (b. Standard
i c. Mountain (=
@,_Pacitis)
e. Other fs Ph, ie
ee SS ene ve) ee Oe
4. Where were you when you saw the object?
. f , ; 4s Ped .
ai / LaLa _ C-< Ef, Glu
ri. Neorest Postal Address 4 City or Town State or Country
,* Z : A -
tae 4 FE.47° Lv Foe a a fac,
Additional remarks: —+-<—~ = Zz : — _ nia
; — = aah = = ——— . os és sanenee — ‘
presig a P -_ 4
; .- -. a Cc’
5. How long wes object in sight? eo ew FRR (coal SES <a
Hours Minutes Seconds |
; ‘ ‘ ‘ . ,#
5-1 How was time in sight determined? Ga. eK hy . Br ee
3. Certain <Not very sure |
b. Fairly certain d. Just a guess
6. What was tr+ condition of the sky?
| |
DAY NIGHT
3. Bright o. Bright
} b. Cloudy Cb. Cloudy
7. IF you saw the object during DAYLIGHT, 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
a POM

haeolete

FTD JUL 6] 164 Thiaform supersedes ATIC 164, Feb 69, which Ia o

i

—

8. IF you saw the object.at NIGHT, what did you notice concerning the STARS and MOON?

8.1 STARS (Circle One): 8.2 MOON (Circle One):

a. None o.C Bright moonlight '

b A iow b. Dull moonlight

¢. Many c. No moonlight — pitch dork
d. Don’t remember d. Don’t remember

Pou 2

9. The object appeared:

—

—

(Circle One): <a Asa light b, Shiny c. Dark d. Don’t remamber

a

10. If it appecred as a light, was it brighter than the brightest stars? ~ A eb LE Cm Cp
pf ts a a Ler
ll. Did the odject: (Circle One for each question)
0. Apoecr to stand stil! at any time? (Yos” No Don’t Know
b. Sudsenly speed up and rush sway at any time? Yes No Don’? Know
¢. Breck up Into parts or explode? Yes CNe Don’t Know
J. Give off smoke? Yos CNo’ Don't Know
2. Chonge brightness? Yes (No? Don’t Know
f, Change shepe? Yos No Don't Know

12, Did the object move behind something at any tlma, particularly o cloud?

ioah or flicker? Yes
D!seppear and reappear 7 You

(Clrele One): RGry: No... Don't Know. _, IF you answered YES, then toll what

-
nS he sea ee PEE at tn Me RE -

Jv ;
LAE OC ot

It moved behind:

(ZeEf" 4.

A
-~* —“<_

Don't Know
Don’t Know

awe im

13. Did the object move in front of something ot any time, particulorly.o cloud?

(Circle One): Yes (No Don't Know.
In front of: _

IF you answered YES, then tell whet

—_—_ —
-_<-eoeoeo

— —__—
———— enw errr -__ _-- —_ cE

14, Did the object appecr:  (Cirele One): Ca, ‘Solid’ b, Transpereant c. Vapor

= =
— —_—— —~

—_—-- — -——_ - —~

d. Don't Know

—— — ——--— ---

15. Did you cbserve the object through ony of the following?

a, Eyeglesses Yes (No e, Binoculars You
b. Sun glasses Yes (No f. Telescope Yes
Cc. Windshield Ye 4 ‘4 Ne 5. Th } wlolite Yes
J. Window gla: Yo: (No h. Orher -E<zA wrt i

Me

Ss
re No

7
\No |

— . . ee eee ee Bee OOO eR © et ee -- ~— se Powe ee _ — -——- -~-

Page 3

———

16. Tell in a few words the following things about the object, |
4 — fy A . ¢ / | cnenre ;
a. Sound Lees . Sit C270 APCIUALE LL fe c |
ron ‘ra ee 15
b. Color i) Ct 497 -2ZO tf CF) af Lecd
y

17. Draw a picturs thot 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 vopor trails.
Place on crrow beside the drawing to show the direction the object was moving.

ROT em
Lor

= &eL ile ws

f a fle dA FE LICHWS vit? CARE (FOP AAR: J y ere J wef e
ne ‘7 PONE LIKE
120 9 / i es — ~~ mes rot ur}
AS iCGuis ?—2 I, dn - . = a
‘ 4 Wi 2? \ Vy Keep nd aE Cie. -_ iam. —
<a - ;
\ "ils
~
i
i Ag?
~ fi-~ {Tr
; n .
18, The edges of the object wars:
(Circle One): go. Fuszy or blurred)
b, Like a bright stor
a Sharply outilaed

d. Don't remember

-
q ————— -— —_—_—-__— —_ -

19, IF thers wes MORE THAN ONE object, then how many wore there?

Drow a picture of how they were crranged, and put an crrow to show the dirsction that they ware traveling.

Pegs 4

20. Draw a picture that will show the motion that the object or objects made. Place on “A” at the beginning of
the path, a “*B’’ at the end of the path, and show any changes in direction during the course.

TER

-—_—-_----- —_ —

21. How lorge did the object oppear to you as compared to an object with which you cre familiar?

wr

4 a Z - J 2 y~ ‘ P -
Cte ost{t ad CCRT cia Ot Lec wmge Creick , li oot 24 bewk
— —_— — —--- —_——
¢

a —

22. Vio wish to know the angular size. Hold a match stick at arm's length in line with a known objsct.and notes
how much of the object is covered by the head of the match. If you hed performed this oxperiment at the time
of the sighting, how much of the objset would have been covered by the match head?

LQ ve Lind cote Cel Kcedec’ Fe arreres 10 vxtth oo

a : y Arie > -<¢€ J
- =

23, Did the object disappear:while you were watching It? If s0, how? A-@

24, In order ther you can give as clecr a pictura os possible of what you sow, describe in your own words o

common object or objects which, when ploced up in the aky, would give the same appecrance as the object
which you sew.

“7 f J Py ~ ; f >

C sey thictlan? (sacs bee?)
’ f
/ i

a

25. Where were you locoted when you saw the object? 26. Were you (Circle One)
(Circle One):
a. In the business section ofa city?
o. Inside a building Cb, In the residential saction of a city®
b. Ino cor c. In open countryside?
€ Outdoors) d. Near an airfield?
d. fh Gn airplane (type) e. Flying over a city?
o. Atsec f. Flying over open country?
f, Other _ L g- Other _
phoney m | =

— 7 ,
’ - - - v
. 7 Z a
ls = ¢ ae al 2h: oe = CFL Zz , < Ct. uel 4 ee “<4 £ y < < , Sof é 4 3.
BOB - — _ ———— = oa o
; °
, 0 y ne . P, J A S ¢
iy cc of Tre, of <T- nM oe Tix. fi-ts C4 _ bE ese
~ —— —
vy o ¥
) a = / a
= =
ar me : - te , -
— tte = / a f Cerne PLY i <a aft - ' eZ = at Fins z. / th

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

28.1 Wher diraction were you moving? (Circle One)

c. North c. East e. South g. West
5S. Northeast d. Southeast f. Southwest h. Nerthwest
28.2 ow fast were you moving ?_ miles per hour,

28.3 Od 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)

ae g. West

a. North c. East S$. South h. Northwest

b. Northecst d. Southeast f. Southwest i. Overhead
30. What direction were you looking when you last saw the object? (Circle One)

ae g. Wast

(a. North ec. East e. South h. Northwest

b. Northees? d. Southeast f, Southwest i. Overhead
31. If you cre ‘amiliar with bearing terms (angular direction), try to estimate the number of degraes the object wos

from true Nerts (thru east) and also the number of degrees it was upward from the horizon (elevation).

31.1 When it first oppecrad:

a, From true Nerth degrees.
b. From horizon degrees.

31.2 When it disappeared:

a. From true North degrees.

b. From horizon. degrees.

lsinsonen

Page 6

A

32. In the following sketch, imagine that you are at the point shown. Place an “A” on the curved line to show how
high the object was above the horizon (skyline) when you first saw it. Place a “B” on the same curved line to
show how high the object was above the horizon (skyline) when you last saw it. |

33. In the following larger sketch ploce an “A” at the position the object was when you first saw it, and a “B” at its
position wren you /ast saw it. Refer to smaller sketch as an example of how to complete the larger sketch.

——— =

bn eee