PROJECT BLUE BOOK

1. DATE - TIME GROUP
10

3. SOURCE

Civilion

4. NUMBER OF OBJECTS

One

5 Minutes
6. TYPE OF OBSERVATION

Sround<visual
7. COURSE

O Yes
SC No
9. PHYSICAL EVIDENCE

O Yes

PRN

FORM
FTD sep 63 0-329 (TDE)

‘arch 65 10/14402

5. LENGTH OF OBSERVATION

2. LOCATION

10. CONCLUSION
bALL ON

!

Object in ac
Sun was over ric

8. PHOTOS b 1S:

bbservition.
‘oul ? hay 1, ery etn

,
mma AN i. hy }

Previous editions ef this form mey be used.

11. BRIEF SUMMARY AND ANALYSIS

>
seontinuous

Fal ‘ . 7 ' * ae —s ‘
sly for about 5 min. Lookin: NE ary!
nicer, Ob. ey ppe ma d sol13 d, erin & i
2 gr") : ; {
,
v ‘ i
ou ‘ ¥ Se j bn ’ ‘
. | 13! bert ct

U.S. AIR FORCE TECHNICAL INFORMATION

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 that you have observed,
Please try to onswer as many questions as you possibly can. The information that you give wil!
be used for research purposes. Your name will no? be used in connection with ony statemenis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed necessary, we may contact you for further details.

1, When did you see the object? ; 2. Time of day: —//.— Ge.
tious Minutes
ia] 7 - ros fe a Pecan
Ly wit st A ‘ie sae (Circle One): A-M. / or P.M.
Day Month Yeor
3. Time Zone: ———
(Circle One): co, Eastern . (Circle Une); a, Daylight Soving }
b. Central b. Standard ©
c. Mountain
d. Pacific |
e. Other |
4, Where wers you when you sow the object? |
ye
Nearest Postal Address City or Town . State or County
5. How long was object in sight? (Total Duration) wi of ;
Hours Minutes Seconds i
a. Certain ¢. Not very sure :
cb. Fairly certain d. Just o guess
5.1 How was time in sight determined? te 2 , = ;
5.2 Was object in sight continvousty? Ye — Ne'. aaa ao cin j Pe * ‘
6. Whot was the condition of the sky? .
>?

DAY NIGHT

a. Bright | a, Bright
b& Cloudy’ ° b, Cloudy
7. IF you saw the object during DAYLIGHT, where was the SUN locoted a3 you looked ct the objest? hee oe
(Circle One); a. In front of you d. To your left Katee y fF eth ete | ES
b. In bock of you e. Overhead mitepte Seiie Bhp jyti;
_ . To your right= f. Don’t remember 1 iF” RM, J ae”.

FORM
FTD oct 462 164 Thle form supersedes FTD 164, Jul 41, which Le obsolete.

a Oe ae ee ee ee

Page 2

8. IF you saw the object ot NIGHT, what did you notice conceming the STARS and MOON?
B.1 STARS (Circle One): 8.2 MOON (Circle One):
a, None a. Bright moonlight
b. A few b. Dull moonlight
c. Many c. No moonlight — pitch dork
d. Don't remember d. Don’t remember
9, What were the weother conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky a. Dry
b. Hazy > b. Fog, mist, of light rain
c. Scattered clouds ¢. Modercte or heavy rain
_d. Thick or heavy clouds d. Snow
e, Don’t remember
10. The object appeared: (Circle One):
on Solid 3. Asoo light
b. Transgarant », Don't remember
c. Vapor
11. {ff it appeared as a light, was ! orighter than the Srightest sters? (Circie One): |
@, Srignter Cc, About the same Be ae Bite fb tA
b. Dimmer d. Don’t know ; Aree — tif}
bb v2 CS En 1 Fis }
11.] Comeare rightness to some common obiect: i k Wf BZ od L254 SCE ee
é IK boro i de _ a Te poet ;
12. The edges of the odject were:
(Circle Ore); a, Fuzzy or dlurred a. Other _ rw
2» Like a bright stor
c. Gharply outlined ;
d. Don't remember
. Did the cbiect: (Circle One foe sach question) .
a. Appecr to stand still ct any time? Yeas” No Den’? know
b, Suddenly speed up and rush away at any time? Ve» No Don’? know 3
c. Break up into parts or explode? Yas No Don’t know
d. Give off smoke? Yos No Don’t know 4
e, Change brightness? _Yos No Don’? know ‘
f. Change shope? Yos No Don’t know
g- Flash or flicker? Yos No) Don’? know ;
h. Discopear and reappear? Yes No > Don’? know

14, Did the object disappear while you were catching it? |i so, how?

Fatale OP ae ae
Pe Se

“

Page 3
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x rg i Ss. ~ fo ie Pa tes ; z, x Pa
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oe ee 7

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15. Did the object move behind something at any time, particularly a cloud?
(Circle One): Yes (No ) Don't Know. IF you saswered Yb, then tell what
it moved behind: _ ..___. z
16. Did the objeet move in front of samething at any time, particularly a cloud?
(Circle One): Yes (Ne Don’t Know. IF you answered YES, then te!! wisat
in front of: Pe ede A. ae " s geen!
17. Tell in a few words the following things about the object:
a, Sound Liz SP Jenn” a aS oak PES aS — “Lik
b. Color _ £2 it A, . anni = : :
18. We wish to know the ongulor size, Hold a match stick at arm’s length in line with o known object and ner ow

much of the object is covered by the head of the match. If you had performed this oxperiment at the time of thn
sighting, how much of the object would hava been covered by the match head?

SE: -_
”
pire LY OI eG iC.

”

19. 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., and especially exhaust trails or vapor trails.

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

Top.

f ‘

{
; i bombo: “i ff?
’ - : P| ;
Liaw: = ra — fe
. ~
fy p r ;
fo ‘ff , f 4
7 ~¢ Le} ~ -

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

(Circle One) Yes No , . ae see “pe

pte

IF you answered YES, then what spead would you estimate? mee

eee

oo =~ wee —, -——— —_ _ ee

21. 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? =» co Heb

—— ——

22. Where were you located when you saw the object? 23. Were you (Circle One)
(Circle One):

a. in the business section of a city?

2, Inside a building b. In the residential sect:on of o city?
b. Ina car c.C[z open countryside?

d. Near an airfield?

e. Flying over a city?

€. Qutdoors*

d. In an airplane (type)
e. At sea f, Flying over open country?
Other te aa hal erate ie a a i es | g; Omer 2.2

_——- mee wee ee —— — —_ _— oe = Hee - ee

24. 1 F you ware MOVING IN AN AUTOMOBILE 9° other vehicle at the time, then complete the followii.g questions;

24.1 What direction wers you moving? (Circ/e One)

a. North ec. East e. South y. West
b. Northeost d. Southeos! f. Southwest h. Northwest
24.2 How fast were you moving? _.._ Smiles per hour.

24.3 Did you stop at ony time while you were looking at the object?

(Circle One) Yes No

- —~—

25. Did you observa the object through any of the following?

a, Eyeglasses Yes Wo e. Binoculars Yes No
b. Sun glasses Yes Wo f. Telescope Yes No
c. Windshieid Yos Gs g. Theodolite Yes No
d. Window glass Yes (NY h. Other ne ee x 233

— ee —— _ - -- te eee eee ee

26. In order that you can give as clear a picture as possible of what you saw, describe in your own words a commor

object or objects which, when ploced up in the sky, would give the same appearance a3 the object which you sow

ee a, 5D, HL 7 — Fy ‘
om fare + phhile Ceirte eT ee i? i awe cle. pa Cte C-eéte«
/ es ’ r sctegl if , -
iy . Pe > a / _—- > fs 7 o. j
6 e ie ie. x sf 74 & Crt ff ©&
“Sf i ff i ae 4. fc! A Lippe . ey - i Pe Kat < Li “ & ¥

Pejeyv

27. In the following sketch, imagine thet you are at the point shown, Place an ‘'A'’ on the curves: line to show how |
high the object was above the horizon (skyline) when you first sow lt, Plocy 9 ““B’’ on the same curved line tc |

show how high the object wos above the horizon (skyline) when you last suw it, Place an ‘A’ on the compass

when you first saw it, Place a ‘'B’’ on the compass where you Jost saw the object.

90°

TS"

28. Draw a picture that wil! show the motion that the object or objects made. Place an ‘*A’’ at the beginning ot ihe
path, a 'B”’ at the end of the path, and show any chonges in direction during the course.

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

—— ae oe a oC mae

Jage 6

30. Have you ever seen this, cr a similar object before. |f so give date or dates and location.

—

31. Was anyone else with you at the time you saw the object? (Circle One) Yes (No

31.1 IF you answered YES, did they see the object too? (Circle One) Yes No

31.2 Please list their names and addresses:

—_— — —_- ———_————- —__—_—_—_~+---——-- +

32. Please give the following information about yourself:

vena , Lost Name a Name =A lene +

ADDRESS ile Cf eek = irt.c;

—s

Street City Zone State

TELEPHONE cc ROW eee SER dot...

indicate any additional information about yourself, including any special experience, which might be pertinenr.

— ——-— — ——_—$_—_—_——_—_-_-—— -_——— —_ ——-+ + are

33. When and to whom did you report that you had seen the object? fe Hii & bf Retet ett Za »

Day Month Year

ee ee we ee te -

Page 7
34. Date you completed this questionnaire: apt Ai Gite IY £5
Dey Month Yoor

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