PROJECT BLUE BOOK

PROJECT 10073 RECORD

2. LOCATION , ,
Columbus, Ohio

10. CONCLUSION
| INSUFFICIENT DATA FOR EVALUATION

1. DATE - TIME GROUP
4 duly 65 _ 04/06802

3. SOURCE -
Civilian

4. NUMBER OF OBJECTS

Not Revorted

Evaluation will be made if form is returned at a future date.

5. LENGTH OF OBSERVATION | 11. BRIEF SUMMARY AND ANALYSIS
, Report eceived that witness had made an observation of an |
ian erie Setiaiton viecives’ ‘toon ts sua cn 2 fuard |
‘| Not Reported ot received or returned from witness. |
7, COURSE. bee:
_Not Reported ee
8. PHOTOS
0 Yes
[Xk No

9. PHYSICAL EVIDENCE ... - .
O Yes
XX No

FORM \ ety? eis we 3.0
FTN sep 42 0-329 (TOE) previous editions of this form may be used.

DEPARTMENT OF THE AIR FORCE
WASHINGTON

OFFICE OF THE SECRETARY

Dear vr.

| Attached is FTD Form 164 which is vsed for |
reporting observations of unidentified flying objects a
to the Air Force. In order for the Air Force to |
evaluate these reports, this form should be completed |
» as fully as possible and returned to this of*!ice. |
|

Sincerely,

phhnal Leck

SARA HUNT
Community Relations Division

Office of Information

1 Atch |
FTD Form 164 |

es . puitiied tiie: Das ait oT ee ee ee ee ae is 5. : gh , — ioe abet adh Ii oe, ae.

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 observe,
Please try to answer as many questions as you possibly can. The information that you give wi!!
be used for reseerch purposes. Your name will not ba used in connection with any 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 sae the object? | 2. Time of day: OF 9. apres «Si
| Hour Minutes
BY 6S |
i 26, SI all (Circle One): A.M. or P.M.
Day Month Yeor
3. Time Zone: eee
(Circle One); Easter (Circle One): a, Doylight Saving
b. Central /b. Standard
c. Mountain ena His
d. Pacific
e. Other

ee a ee ee See Se ee eee

4. Where were you when you saw the object?

Neorest Postal Address City or Town Stote or County
5. How long wos cbject in sight? (Total Duratton) (iscietabmttctenitdctie;: ” steabidlidibdeinaacasanisid
Hours Minutes Seconds
DP a, Certain c. Not very sure
4 b. Fairly certain d. Justa guess

5.1 How was time in sight determined?
ee, /
5.2 Was abjact in sight continuously? Yeo NR east :

SS OE OF ee a ee “_

4
;
t
!
we he a: TE CT I RE eee ee

6. What was the condition of the sky?

;
DAY NIGHT )
O a. Bright a. Bright
; b. Cloudy b. Cloudy i
a eee eee Pena ae te x blll cechedcies aellemp clade a
j
7. IF you saw the object during DAYLIGHT, where was the SUN located os you locked at tha object? ‘
f
(Circle One): a, In front of you 4. To your loft :
p fi b, im beck a? you *, Overheed
te ~ cr ; ' :
: <. +0 your riynit *. Won ? ramemoer
:

Te em ee ey

FORM
FTD OCT 62 154 = Thte form euperaedes FTD 154, Jul 61, which Is obaviete.

ES eee —-

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

8.1 STARS (Circle One):

a,
b.
c.

d. Don't remember

8.2 MOON (Circle One):

a. Bright mconlight

b. Dull moonlight

¢. No moonlight = pitch dark
d. Don’t remember

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

CLOUDS (Circle One):

a. Clear sky
b. Hozy

c. Scattered clouds
d. Thick or heavy clouds

WEATHER (Circle One):
a. Dry |

b. Fog, mist, or light rain

c. Moderate or heavy rain
d. Snow

e. Don’t remember

The object appearad; (Circle One):

a. Solid d. Asa light

b. Transparent e, Don’t remember
Ce Vapor

if it appeared as a light, ‘was it brighter thon the brightest stars? (Circle One):

a. Brighter
b. Dimmer

c. About the same
d. Don’t know

11.1 Compare brightness to some common object:

12. The edges of the object were:

(Circle One): o. Fuzzy or blurred

C b. Like a bright star
c. Sharply outlined
° d. Don’t remember

13, Did the odiact: (Cire/e One for euch question)

a. Appear to stand still at any time? Yes No Don’t know
b, Suddenly speed up and rush away at ony time? Yes No Don’t know
c. Breck up into parts or explode? Yes No Don’t know
a d. Give off smoke? Yos No Don’t know
. e. Change brightness? Yas No Don't know
f, Change shapa? Yos Nio Don’) know
Cc. Pliage “a Moher? Yeas AWD Gon'} au
h, Disappear end reappear? ; Yas No Don’? know

Page 2

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whe Ot Aan 4 ms tants OS
’

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Puge 3

14, Did the object disappear while you were watching it? If so, how?

c

mm a ee wm a eee

15. Did the objact 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:

cree tee eee ee ee

-—-—-——- ———_———— ees mee 6 ee ee oe oe

16. Did the object move in front of sgmething at any time, particularly a cloud?

(Circle One): Yes No Don't Know. IF you answered YES, than tel! wiat
i es ch eae m nsdaien aaipiaidiarhisieai

—e ea 6 ee

re 8 re mm em me

—_— —_——~ S—S—- Seo— — ~- _—_— —_—_—_—_-—_—

oe ee See ee es ee rE ee eee ee OEE & eee

17. . Tell in o fow words the following things about the object:

, :

, b. Col
o or me eee SL aes —-— — —_—_— ee ae ~~ -- ae em ei eee OI I OO Oe ese al  —-_- —
* >

18. We wish to know the angular size. Hold a match stick at orm’s length in line with a known object and nt tow
much of the object is covered by the head of the match. If you had performed this experiment at the time af jhe
sighting, how much of the object would have been covered by the match head?

r

“

| 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 exhoust trails or vapor trails.

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

> eek

oe

x
t .

ee.
}

. ‘ -_ . - ?
SO lk RN AI Se ne Te Oe gn= he

2. Do you think you can estimate the speed of the object?
2 (Circle One) Yes No

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

—=———— es ee

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

2 (Circle One) Yes No

IF you answered YES, then how far away would you say it was?

—_—— en tn a re en te ee eee

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?

a. Inside a building b. In the residential section of a city?
b. Ina cor 2 c. In open countryside?
“J ¢. Outdoors ~ — d. Near an airfield?
: d. In an airplane (type) e. Flying over a city?
e. At sea | f, Flying over open country?
J? a mes bittaciost . g. Other _.._ — and

24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions:
24.1 What direction were you moving? (Circle One)

, a. North ) ce. East e. South y West
"4 b. Northeast d. Southeast f. Southwest h. Northwest

24.2 How fact were you moving? __._____—_miles per hour.

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

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

a. Eyeglasses Yos No e. Binoculars Yes No
- b. Sun glasses Yes No - ~ f, Telescope Yes No /
i ¢. Windshield Yes No g. Theodolite Yes No
d. Window glass Yes No h. Other ____ sili lieing

~

25. in order that you can gives as clear a picture a3 possibis of what you saw, describe in your own words a common

object or objects which, when placed up in the sky, would give the same appecrance as the object which you sow

exe

a ee ee |

’
Oe ee eee er eee

me me = eee ewe - es se =

lege 3

27. In the following sketch, imagine that you ore ef the point shown. Place an ''4."’ on the curved line te show how
high the object was above the horizon (skyline) when you firs? saw it, Place 1 ‘'B'’ on the same curved line ic

show how high the object was above the horizon (skylins) when you last suw it. Place an ‘’A’’ on the compass
when you first saw it. Place o ‘'B’’ on the compass where you last sow the object,

990°

75°

O°

28. .Draw a picture that will show the motion that the object or objects mado. Ploce an “‘A*’ at the beginning of the
path, a '’B”’ at the end of the path, and show any changes in direction during the course.

O

-

= _— oO —

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

- ee

/

tN
2 one ee OK eee +

ain Nn hina a Na

= SS

Page 6
30. Have you ever seen this, or a similar object before. If so give date or dotes and location.
go?
}
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:
First Nome ~H Middle Name ica

a Ce Ch_G L Leyte pices el
City lee State
TELEPHONE — —Y as I cn

indicate any additional informotion about yeuraalf, including any special experience, which might be pertinenr.

Se er Se ee ee

:

33. Whena nd to whom did you raport thet you had seen the object? !
ha : é/ fa 2 ; i

4.
dl

~ —- —~- . —_—--

Day 7 rite Year

Pa

(@ ) ‘ - AD ~~. . - 2 : 8
i/ ; 7 if / ‘ = j . f j ’ a » é - ,
IF OH eg ‘ wy) ue L, Ce Bb dbe ee Orc $e

Office send an FTD Form 164

Ohio, regarding his unidentified
object observation on 4 Jul 65/

(TD
LD [) FORM 9 5 Replaces DD Form 94, 1 Feb 50,and DD Form 48—16—73279-1
. 1 OCT 60 95, 1 Feb 50, which will be used until exhausted,

Columbus,

GoPro

Page B

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-
,
;
2 ae are irre” ce

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— oe ee ee;

—_~—

Poge 7

34, Date you completed this questionnaire:

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

Kiger prheride —t1ty whe - Gy wd 7 Le j fP pia

‘
ee aij
.