PROJECT BLUE BOOK

2. LOCATION

1. DATE -' TIME GROUP Ci
| Hassilon, Ohio

4 ‘duly 65 04/13402
3, SOURCE
Civilian

4. NUMBER OF OBJECTS
One
5. LENGTH OF OBSERVATION
l linute

6. TYPE OF OBSERVATION
Ground =-Visual

10. CONCLUSION
FIREWORKS

Possibly exploding can cover, exploded,

11. GRIEF SUMMARY AND ANALYSIS

Silver-white circular object in flight to SE from NW. Strei
flight. Sky was clear blue, Sighting during bright dayligh

Object &t 3 degrees elevation. Very plane. Quite larze,
went straight up.

t

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8. PHOTOS

FORM

FTD sep 63 0-329 (TDE) previous cditions of this form may bo weed,

Page 5

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 saw it. Place a ‘'B’’ on the same curved line to
show how high the object was above the horizon (skyline) when you /ast saw it. Place an ‘'A’’ on the compass
when you first saw it. Place a ‘‘B’’ on the compass where you /ast saw the object.

90° 75°

28. Draw a pleture that will show the motion that the object or objects made. Place an ‘’A’”’ at the oe FE of the
path, a ''B” at the end of the path, a on show any changes 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 arranged, and put an arrow to show the direction that they were traveling.

Pages |

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

Nowe

31. Was anyone else with you at the time you saw the object? (Circle One)
31.1 IF you answered YES, did they see the object too? (Circle One)
31.2 Please list their names 9 addresees:

ss

32. Please give the followir information about yourself;

NAME
: Middle Neme

ADDRE

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

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33. When ” to whom did you report that you had seen the object? . fi]
RI Fosse Suhy Es" Mina A

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 norrative + gto of your sighting.

———— emer

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 mot 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.

fon.

Hour Minwtes ..,

1, When did you see the object?

2. Time of day:

(Circle One): | (A.M) or P.M.

3. Time Zone:

(Circle One): (G: Eastern) (Cirele One}, Daylight Saving
. Central D. Standarc

c. Mountain
d. Pacific
Se. Other :

4, Where were you when you saw the object?

em eaniay 2 1

5. How long was object in sight? (Tote! Durotion)

Ma ceidfou fi p 2

City or Town State or County

Litt ace intiace:

Hours Minutes

a. Certain ; c. Not very sure
b. Fairly certain cd. _Juata queas>
5.1 How was time in sight determined?
Yes A.

5.2 Wos object in sight continuously? | No

6. What was the condition of the sky?

DA 7 NIGHT |
“a. Bright : a. Bright
b. ouc b, 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 Cd. To your left)
b. jn back of you 2, Overhead.

c. To your right f. Don’t remember

FORM
FTD oct 62 164 This form supersedes PTD 164, Jul 61, which is obsolete. )

a

Ace a Stat ics se tsi tt si tg ee

Page 2

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 Bright moonlight

b, Afew . Dull moonlight

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

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

“ CLOUDS (Circle One):  =-s——SsCS WEATHER (Circle One):
a Hazy | b. Fog, mist, or light rain
c. Scattered clouds . c. Moderate or heavy rain
d. Thick or heavy clouds | d. Snow

e. Don’t remember

10, The object appeared: (Circle One):

d. Asa light

b. Transparent e. Don’t remember
c. Vapor

1]. If it appeared as a light, was it brighter than the brightest stars? (Circle One):

a. Brighter c., About the same
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 star
_ . ‘ .

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 CN») Don’t know
d. Give off smoke? Yes . Nod Don’t know
e. Change brightness? Yes CNo) Don't know
f. Change shape? Yos Don’t know
g. Flash or flicker? Yes No Don’t know
h. Disappear and reappear? Yos a9) Don’? know

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

og compere koi 2 Aaemamemnctamaas

,

15. Did the object move behind something at any time, particularly a cloud?

(Circle One): Yes 457) Don't Know. IF you answered YES, then tell what
it moved behind: )

. ‘ nore we - . —- oes .* -
+ . ---

- : . l*‘

vw? : ? . o**n . '

a

eset 4 - i ie»

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

(Circle One): Yes Sotben (Ne) _. Don't Know. IF you answered YES, then tell what
in front of: mecmeadh

17. . Tell in a few words the following things about the object: |

a. Sound ee EEE oo. aa ee a ea — -

ré

b. Color _> 2k WH Z

18. We wish to know the angular size. Hold a 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 experiment at the time of the
sighting, how much of the object would have been covered by the match head?

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 thet you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails.

Place an arrow beside the drawing to show the direction the object was moving. Jeo Baas | ,

Page 4 .

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

(Cirele One) (Yes “No
IF you answered YES, then what speed would you estimate? 200 -300 MM /es pechr

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

irel |
(Circle One) | (Yes) No L/ ;
IF you answered YES, then how far away would you say it was? _f2 mile. ar less

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

aren a. In the business section of a city?
a. Inside a building ~ In the residential section of a city
b. Ina car c. In open countryside?

d. Near an oirfield?

“d. In an airplane (type). - e. Flying over a city?
e. At sea f. Flying over open country?

ee ee ae NES g- Other
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)

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

24.2 How fast 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 Yes Gs e. Binoculars Yes (Mo)
b. Sun glasses Yes f. Telescope Yes (Ne j
c. Windshield Yes tS g- Theodolite Yes (NS)
d. Window glass h. Other

26. in order that you con give as clear a picture as possible 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 appearance as the object which you sow

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