PROJECT BLUE BOOK

Please try to answer as yquestions as you possibly can. The information that you give will
be used for research purposes. our name will pot 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.
2 Time of day: 6 40
1. When did you see the object?
Hour Minutes
3 NOV. 1965
(Circle One): A.M. or P.M.
Day Month Yoar
3. Time Zone: 17
3. Time Zone: 4
(Circle One): a. Eastern (Circle One): a. Daylight Soving (Circle One): a. Daylight Soving
b. b. Cantral Cantral b. Standard 1
c. Mountain
d. Pocific bocal tewo bcat tewe
e. Other Other
4. Where wers you when you saw the object?
Belmont Belmont OHIU OHIU
Nearest Postal Address City or Town State or County
5. How long was object in sight? (Total Duration) 30
Hours Minutes Seconde.
o. Certain c. Not very sure
Fairly certain Just a quess chuced about
NoX ofter pt n
5.2 Was object in sight continuously?
6. What was the condition of the sky?
DAY NIGHT
a. a. Bright
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 d. To your left
b. in back of you e. Overhead
c. To your right f. Don't remember.
FORM
FTD OCT 62 164 This form supersedes F TD 164, Jul 51, which is obsolete
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a. None a. Bright moonlight
b. A few b. Dull moonlight
c. Many No moonlight - pitch dark
d. Don': remember d. Don't remember
9. What were the weather conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER(Circle One):
a. Clear sky a. Dry
b. Hazy 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):
a. Solid .As a 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 c. About the same
b. Dimmer d. Don't know
11.1
call rend
12. The edges of the object were:
(Circle One): a. Fuzzy or blurred Other treed brihtne b
Like a bright stor Amidb mened
c. Sharply outlined "afthh
d. Don't remember soys ete
Did the object: (Circle One for eoch 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. Givs 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

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they
15. Did the obisct 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 benind:
16. Did the object move in front of something at any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, then tell what
in front of:
17.  Tell in a few words the following things about the object: (ddit ak)
a. Sound
b. Color_
18. We wish to know the angulcr 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?

(Circle One) Yes No
IF you answered YES, then what speed would you estimats?
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 wou! Id you soy it was?
22. Where were you located when you saw the object? 2. Were you (Circle One)
(Circle One):
a. 1 In the business section of a city?
a. Inside a building b.) In the residential section of a city?
b. In a car c. In open countryside?
Outdoors d. Near an airfield?
d. In an airpiane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. g. Other
24.1
24.1 What direction were you moving? (Circle One)
. North c. East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
didintark

callen couldid estionmatle tie angle in Nhy , but
90
said it war highuenorgh to be cleanly
60
visille
NW N
:
30
E
15° SW
35
4
Draw a picture that 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 changes in direction during the course.
44
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Was anyone sise 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:
1.
) Mrs.
32. Please give the following information about yourself:
NAME
First Name Middl Name
Belmont OHIO
ADDRESS
Street City Zone State
TELEPHONE NUMBER AGE SEX M.
ataled
that be had called wtio
Day Month Year
nadio. Ihe tld hi t cll FTD

dired lige beteveen Mr
hame and Cincinnatta.
Mr. speach wan thick and
shured.Mro. spech appeared
romehat slred also, Mr
speech did not 20
FTD Duty officen
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