PROJECT BLUE BOOK

1.’ DATE". TIME GROUP 2. LOCATION
31 May 65 01/00352 Belmont, Ohio

3. SOURCE ~ 110. CONCLUSION
Civilian UNRELIABLE RuPORT

4. NUMBER OF OBJECTS
Witness playing prank by calling in fake U?TO report. Reported
to Dayton City Police.

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

haan oe vo Cevirsus rere: pres

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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 answer as many questions as you possibly can, The information that you give will
be used for research purposes. Your name will not be used in connection with any statemenis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed necessory, we may contact you for further details.

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—-—— — —————— me = —— — ee = aaa ee —— —_— —

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]. When did you see the object? _—_. , 2. Time of day: ihe Bea ss wre a |
a ‘1 Se Hour Minutna
5 ag A A a ee ae
pe —LGHY A i a Mle TEE (Circle One): A.M. or /'PLM. .
Day Month “ Your oe”
3. Time Zone: : cai
(Circle One): a. Eastern (Circle One); a, Daylight Saving
pM b. Standard
¢. Mountain
d. Pacific
e. Other —

4. Where were you when you saw the object?

—_— iy

Necres? Postal Address City of Town State or County

eg, 7 on 7
{eet Mén

——— «et ee ee ©

5. How long was object in sight? (Total Duration) detipesiasienanions “-asititinmnanainasin,
Hours Minutes Seconds
a. Certain c. Not very sure
b. Fairly certain d. Just a guess ’
5.1 How was time in sight determined?
5.2 Was object in sight continuously? Yes _i" No
6. What was the condition of the sky?
_ DAY NIGHT
fy Bright a. Bright
b. Cloudy b. Cloudy

7. IF you saw the object during DAYLIGHT, where was the SUN loccted as you locked at the objext?

SOS er, Ae

(Circle One): In front of you d. To your left
(b/ In bock of yeu e. Overhead
- To your right f. Don’t remember
Bin Op ig IER Geiger i ee

FORM
FTD OCT 62 164 = This form supersedes FTD 164, Jul 61, which is obsolete.

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

8.1 STARS (Circle One): 8.2 MOON (Circle One):
a. None a. Bright moonlight
b. A few b. Dull moonlight
c. Many ¢. No moonlight — pitch dork

d. Don't remember d. Don’t remember

9. What were the weather conditions af the time you saw the object?

CLOUDS (Circle One): WEATHER (Circle One):

Qe Clear sky a. Dry
~b. Hazy b. Fog, mist, or light rain
c. Scattered clouds c. Moderote or heavy rain
d. Thick or heavy clouds d. Snow
e@. Don’t remember

10. The object appeared: (Circle One):

(a) Solid d. Aso light
b. Transperent e. Don’t remember

c. Vapor

11. If it appeared as a light, was it brighter than the brightest stors? (Circle One):

a. Brighter c. About the sqme ‘
b. Dimmer d. Don’t know '

11.1 Compare brightness to some common object:

12. The edges of the object were:

(Circle One): a. Fuzzy or blurred | e. Other
b. Like a bright stor

c. Sharply outlined

d. Don’t remember

13. Did the object: (Circle 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 parts or explode? Yes No Don’t know
d. Give off smoke? Yes No Don’t know
e. Change brightness? Yes No Don’t know
f, Change shape? Yes No Don’t know
g- Flash or flicker? | Yes No Don’t know

h. Disappear and reappear? Yes No Don’t know