PROJECT BLUE BOOK

This questionnaire baen prepared so that you can give the U.S. Air Force as much
information as possibl oncarning the unidentified aerial phenomenon that you have observed.
Please try to answs any quastions as you possibly can. Ths information that you give will
be used for resear poses. Your name will pot be usad 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.
1. When did you see the object? 2Time of day: 45
Hour Minutes
15 November 1965 (Circle Ons): A.M. or P.M.
Approx Day Month Year
3. Time Zone:
(Circle One): a. Eastern (Circle One): a. Daylight Saving
b. Contral b, Standard
c. Mountain
d. Pocific
e. Other
4. Whore wore you when you saw the object?
Middletawn Middletawa Crange County N.Y Orange Connty N.Y.
Nearest Postal Address City or Town State or County
5. How long was objsct in sight? (Total Duration) 2 30 35
Hours Minutes Saconds
.Cortain C. Not very sure
. Fairly certain d. Just a guess
5.2 Was obiect in sight continuously?
6. What was the condition of the sky?
DAY NIGHT
a. Bright a. Bright
b. Cloudy
7.IF you saw tho objoct during DAYLIGHT, where was the SUN located as you lookod at the object?
(Circla One): a. in front of you d. To your left
b. In back of you o. Ovarheod
c. To your right f. Don't romember
FORM
FTD OCY 62 164 This form supersedes F which is obuolats.

8.2 MOON(Circle One):
a. None a. Bright moonlight
b. A fow b. Dull moonlight
c. Many) c. No moonlight - pitch dark
d. Lon't remember d.Don't remember
. What were the weather conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER(Circie One):
a. Clear s G. Dry
b. Hazy b. Fog, mist, or light rain
c. Scatrered clouds Moderate or heavy rain
d. Thick or heavy clouds d. Snow
e. Don't remember
10. Tho object appeared: (Circle One):
a. Solid (d. As a light buticouldsee itwas solid
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 b. Dimmer d. Don't know
11.1 Compare brightness to some common object:
1.The sdges of the object wers:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright star
Sharply outlined
d. Don't remember
13. Did the object: (Circls One for eoch question)
c. Appear to stand still at any time? Yes No Don't know
b. Suddenly speed up and rush away at any time? e No Don't know
c. Break up into parts or exploda? Yes No Don't know
d. Give off smoke? Yos No Don't know
Change brightness? Yas No Don'i know
Chonge shapo? Yes №\o Don't know
G. Flash or flicker? Yes) No Don't know
h. Disappear und reoppear? Yas No Don't know

Page 3
4. Did the object disappear while you wers watching it? If so, how?
15. Did the object move behind something at any tima, particularly a cloud?
(Circle One): Yes No) Don't Know, IF you answered YES, then tell what
it moved behind:
16. Did the object move in front of something at any time, particularly a cloud?
(Circie 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:
c.sound twsiient
b. otor It flahad sed green and white liglit
Ws wish to know the angular size. Hold a match stick at arm's langth in line with a known objoct 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
roratingdisc
withthe
ligsysit
was on bottom
of the object

2. 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 soy it was?
22. Whers were you located when you saw the object? 23. Were you (Circle One)
(Circie One):
a. In the business section of a city?
a. Inside a building b. In the residential section of a city?
b.In acar c. In open countryside?
Outdoors d.Near an airfield?
d. In an airplane (type) e. Flying over a city?
o. At sea f. Flying over open country?
F. Other - J. Other +
24.1 What direction were you moving? (Circls One)
. North c. East . South 9. Wost
b. Northeast d. Southeast f. Southwest h. Northwest

A.B
A.B
. NW NE
5
13 3W
35
Draw a picture that will show the motion that the object or objects mada. Place an "A" at the beginning of th
path, a "B" at the end of the path, and show any changes in direction during the course.
29. IF there was MORE THAN ONE object, then how many were thers?
Draw a picture of hoy they were crranged, and put an arrow to show the direction that they were traveling.

31. Was anyone slse with you at the time you saw the object? (Circle One) Yes No
31.1 IF you answered YES, did thoy see the object too? (Circle One) Yes No
31.2 Please list their names and addrosses:
11
matlet n.y.
32. Please give the following information about yourself:
NAME
Last Name First Name Middl Nam
ADDRESS middliton
Street City Zone State
TELEPHONE NUMBEI AGE 14 sEx Diace
T
33. When and to whom did you report that you had saen the object?
Day Month Yoar
i+ wasnt reported

it went eastuard at a rapid
rate of speed, stopped for abouit
noute back At stopped at The
spot
2 seconde then
a