PROJECT BLUE BOOK

1. DATE. TIME GROUP

20 Nowember 64 21/0105
3. SOURCE 10. CONCLUSION
Civilian CONFLICTING DATA
4. NUMBER OF OBJECTS
One
5S. LENGTH OF OBSERVATION |11. BRIEF SUMMARY AND ANALYSIS
35 Seconds Object. like North Star in sight for 35 seconds. oe

|

No sound. Disappeared by fading. Sharply outlined. Speed

6. TYPE OF OBSERVATION estimated at 2-4,000 mph. Straight flight. Could have been] |
Ground-Vis ual in outer space, Observation in NE |

¢ GOUntS OMMENTS: Initial letter indicated that the object was moving at
West 500-700 mph. Initial letter indicated that the object was obseyved

8. PHOTOS in the West moving NW. Also object was reported to disappear irjto
thin air, not fade. ECHO I and IT not in area at reported time

O Yes f observation. Case regarded as conflicting data in view of the
MX No I facts as stated in the orginal letter ani those reported on the

9. PHYSICAL EVIDENCE Form 164, See © Avg 64 Abo.

O Yes

Xx Ne

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

20.

— fpeeitede)

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? ae? A-4000 Mp H.

21.

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

(Circle One) Yes No

IF you anateitee YES, then how far away would you say it was? 300 LATE AS PLIAN”

, Where were you located when you sow ‘the object? — ‘| 23. Were you (Circle One)
(Circle One): eae ey a ee es er
id ; a. in the business section of a city?:. an) ©
a, Inside a building Cb) In the residential section of a sey? i
b. Ina cor a c. In open country side?
c.{ Outdoors ‘ d. Near an airfield?
d. In on airplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. Other g- Other

24.

IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the karing questions:

— . ‘ = — . —

24.1 What direction were @ you moving?. (Circle One)... ee: ESS

a. North "os 2 ce. East'» e,. South , yg. West <
b. Northeost : d. Southeast f. Southwest - ©» he. Northwest
24.2 How fast were you moving? miles ner hour. ry : paacaink i

24.3 Did you stop at any time while you were looking at the obiect?
(Circle One) Yes No

— a

25.

Did you observe the object sc any of the following? ~ ~~~ Sone pteeadesida

“oC Eyeglasse> * ‘ No" me e. Binoculors “Yes | No OA? S8utei? & wn

b. Sun gicsses = “No |) f. Telescope ” Yes" = No © Frise 2
c. Windshield Yes , No ’ g- Theodolite : Yes 372 ; No (. woTD —
d. Window glass Yes - No h. Other

———--- ———_

|

'
'

—_——

26.

in order that you con give as clear a pictures as possible of whet you saw, describe in your own words a common

object or objects pie he when placed up in the sky, would give the same appecrance os the object which-you sow

: ) . > ae ax 2 Sm a fv) Pe TY n> : r mY 9 i>
Osd) +f tu 2) WA ‘ “2, aid! CUCU 7 SS jo ‘AS, A - i ‘ Ae 16 Mou ha ed YS NZ,
> } VL 2s os a \ : 2a +~ + + i
's.

ry Pe “Tt A f a, wht PB f
/ Sond. f j ‘ Re . - > 50 »- HHA ae me Rowe ae) i ' o ss ’ A\é oF aM Wy ,

“SD eh ee

ee

omeee

27. 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 sow it. Places a ''B”’ on the same curved line to
show how high the object wos obove the horizon (skyline) when you /ast saw it. Ploce an ‘‘A"’ on the composs

when you first saw it. Place o '’B’’ on the compass where you /ast saw the object.

8o°

75"

— —— —— —_———- — — —- —— - ——_——- so -_— — —_ _——.

28, .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 change: in direction during the course,

— Fi
Morioy, STRAIGHT

2 lll

29, IF there was MORE THAN ONE object, then how many were there?
Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.

tage 6

—— —— —— eee

30. Have you ever seen this, or a similor object before. If so give date or dates and location.

ee ay,

31. Was anyone else with you at the time you saw the object? (Circle One) Yes) Kio
. Ti,
31.1 IF you answered YES, did they see the object too? (Circle One) Yes) No

31 2 Please list their names and addresses:

‘

Middis Neme
mi /

“ vd Sa *

a — ee ee ee

|
|
|
|
|

Zore Si ae

TELEPHONE NUMBE

Nip eh

: OF O's 4d Qe dirt ot ATA. Sinn. LULL
er scare ay xy Dp 2 secu, OO woe! aur RACED.
QC) + ons BLL SW ODS ts pmohks sure,

indicate any dine ret, about yourself, including any special experience, which might be pertinent.

33. When and to whom did you report thot you had seen the object?

.

Dp yy Month Yoor f

ae Fe 2 ee

2 ee ee OL ee Le

Creer ee ee eee Oe ee

———- <6)! ew er

ee

Page 7

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~ F } ay am ["—7 j Ht, : +
34. Date you completed this questionnaire: ae ee oe, I
Day Month Yeor

--- —

35. Information which you feel pertinent and which is not adequately covered in the specific points of the
questionnaire of a norrative explanation of your sighting.

ne ee lester bbe sb cold. honed

LX)
; tun, OF; divopase.ran. Ib pelt
= ( could. fae 4 P20 L LBD ke at Tham

ish. Jhat SHY or ¢7: very bh, di)

oe 7 oe ee” Ge

FIGHT Ti
sl UTHE~

aR IN

(PRosect OLUE Boo i)
DEPARTMENT OF THE AIR FORGE
OFFICE OF THE SEORE TARY
OmitéO STATES AIR FORCE
WASHIVGTONU, D.C. AO3ZO0

a.

OFFICTAL IBUSIMUESS

-— -~-+

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ne |

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a

24 November 1964

—_ ~<- — ——

Onn: TE
With reference to your recent letter, attached

is FTD Form 164 to be used for reporting UFO sightings
to the Air Force. |

Sincerely, pencil

MASTON M, JACKS
Major, USAF
Chief, Pictorial Branch
Public Information Division |
Office of Information

1 Atch
FTD Form 164

~~ * = oo " ~~ =

Lakeland, Vlorida

U.S. AIR FORCE TECHNICAL INFORMATICN

e This questionnaire has been prepared so that you can give the U.S. Air Force as much
| information as possible concerning the unidentified cerial phenomenon thot you have observed,
Please try to answer as many questions as you possibly can, The information that you give wil!

be used for research purposes. 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.

_ ———————— _—_———- ——————————— ee — —— ——

Hour Minvies —

2O Ty : {9 64 | (Circle One): A.M. or G>

Day Month Yeor

1. When did you see the object? 2. Time of day: a a C); : en

—_— _

3. Time Zone:

(Circle One): a. (Easter (Circle One); a, Daylight Saving
b. Central b. “Stande
c. Mountain
d. Pacific
e. Other

-— a . — ote _~ -

— eS —_— —_——- ——— _—

4. Where were you when you saw the object?

| IB fo ko fnd, x Oa
cores? Posta se City of Town Stote or County

— —

—— =

5. How long was object in sight? (Total Dwetion) © 9 = 5
i Hours — - Minutee----— Seconds-“—. -
a. Certain c. Not very sure

bi Foirly certain) d, Just o guess,

5.1 Hew was time-in sight determined? Be Cy OALN
5.3" Wes object In sight continously? Yes —X_ No

— ~-

allie

; 6. What was the condition of the sky?

7 te Se eee Oe ee et eee wee se ee ee o) ee ie eee

| DAY NIGHT
| o. Bright a. GrighdD
| b. Cloudy b. Cloudy
7. IF you sow 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 loft
b. In Sock of you s, Overhead
4 c. To your rignt t, Don’? ramember

ee ae ee Ce ee a eee :
a ST Sg ,

FORM
FTD oct 62 164 This form supersedes FTD 164, Jul $1, which ie obsolete.

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
b. “A fow>

c. Many
d. Don't remember

a, \Bright moonli

——

Bright meonlighb {GK amon,

b. Dull moonlight
c. No moonlight — pitch dork
d. Don’t remember

Page 2

—_— —

What were the ene conditions at the time you saw the object?

“““CLOUDS (Circle One); ~~

a. Clear sky> ere

b. Hazy
c. Scattered clouds |
d. Thick of heavy clouds

o. Op

d. Snow
e@. Don’t remember

a OO Fe - - --- - =

WEATHER (Circle One):

b. Fog, mist, or light rain
c. Moderate or heavy rain

The objec? appeored; (Circle One):

a. Solid d< Asa light)
b. Transporent @. Don't remember

c. Vapor

Il. if it appeared as a light, was it brighter than the brightest stars? (Circle One):

11.1

c. About the same
d. Don't know

a. ‘ Brighter)
b. Dimmer

Cc © brightness to some c object;
aon Loa Omit aD or bk an th, mm D soa. :

———

12. The edges of the odject were:

(Circle One}: a, Fuxzy or blurred

b, bright stor
c. ‘Shorply ovtli
d. Don’t reme —— ar"

13. Did the object:

—— $$$

a. Appear to stond still at ony time? Yes
b. Suddenly speed up and rush oway at ony time? Yos
c. Break up into ports or explode? Yes
d. Give off smoke? Yes
e. Change brightness? Yes
f, Change shaps? Yes
: 3. Filoah or flicker? Yos
j h. Disappeos and reappwor? »oocuptes

No
(No
No)

ND

>as

No

(Circle One for each question)

Don’t know
Don’? know
Don’t know
Don’t know
Don’? know
Don’t know
Don’t know
Don'? knew

es eee

A

14, Did the object disappear while you were watching, it? If so, how? OD ALT! S Lb vad ( ok AQUTLIA..

V
Qe id Limeiing uN Lsth tha ANALY /
J
15. Did the object move behind something at any time, particularly a cloud?
(Circle One): | Yes. Don’t Know. IF you answered YES, then tell what
it moved behind; —- Se : te sMenct Accord

16. Did the objee? move in front of gamething at any time, particularly a cloud?
(Circle One): Yes (No, Don't Know. IF you answered YES, then tal! wiat

in front of: oir

— =——— _—-

17. . Tell in a few words the following things about the, re

much of the object is covered by the head of the match. |f you had performed this experiment at the time of the
sighting, how much “i the opject would have been covered by the match head? O92, a Hng,

18, We wish to know the angular size. Hold a match stick at arm’s length in line with a known object and nota :
UFO. 409 HoOwy Yon. CONE,

-——

19. Drew 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., and especially exhaust trails or vopor trails.

Place on orrow beside the drawing to show the direction the object was moving. .

= J
Se

ee pene USERY FAST ae
enn 2 ‘

\,
UFO.

LA
c
SOM EOL TO me Se

- ——-
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