PROJECT BLUE BOOK

be used for res name will not be usad in connection with any statements,
conclusions, or publications without your parmission. 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? 2. Time of day: 17
Hour Minutes
15 Novel1 1965 (Circle One): A.M. or P.M.
Day Month Year
3. Time Zone:
(Circle One): a, Eastern (Circle One): a. Daylight Saving
5. Centrat b. Standard
c. Mountain
d. Pacific
e, Other
4. Where were you when you saw the object?
Columbis
5.2 Was objecr in sight continuously? Yes No
6. What was the condition of the sky?
DAY NICHT
a. a.$ Bright
b. Cloudy 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 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FTD OCT 62 164 This form supersedea FTD 164, Jul 61, which is obsolete.

Pogo 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
b.A few Dull moonlight Full meon dhe soo
c. Many c. No moonlight - pitch dark
d. Don't remember
9. What were the weather conditions at the time you saw the object?
CLOUDS (Circis One): WEATHER(Circle One):
a. Clear sky a. Dry 7
b. Hazy b. Fog, mist, or light rain
c. Scattored clouds Moderate or heavy rain
d. Thick or heavy clouds d. Snow
e. Don't remember
10. The object appeared: (Circle One):
a. Solid d. As a light
b. Transpcrent b. Transperent Don't remember
c. c. Vapor
1. If it appeared as a light, was it brighter than the brightest stars? (Circle One):
a. Brighter a. Brighter c. About the same
Dimmer d. Don't know
11.1 Compare brightness to some common object:
Buhteon Cny
12. The edges of the object were:
(Circle One): a. Fuzzy or blurred
. Like a bright stor
Sharply outlined
d. Don't remember
T3. 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. Breck up into parts or explode? Yes NO Don't know
d. Give off smoke? Yes No Don't know
a. Change brightness? Yes No- Don't know
5. Change shape? Yes No Don't know
g, Flash or flicker? Yas No Don't know
h. Disappear and reappear? Yas No Don't know

14. Did tha object disappear while you wars watching it? If so, how?
15. Did the object movs 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:.
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. Tall in a few words the following things about the object:
a. Sound_
s. color Bedihet boec fiit
8.We wish to know the angular size. Hold a match stick at arm's length in line with a known object and nots how
much of the object is covered by the head of the match. if you had performed this experiment at the time of the

22. Where were you located when you saw the object? 23. Were you (Circle One)
(Circle One):
a. In the business saction of a city?
a. Inside a building b. In the residential section of a city?
b. In a car c.In open countryside? Iishery40
c. Outdoors d. Near an airfield?
d. In an airplone (type) e. Flying over a city? IS-70
e. At sea f.
f. g. Other_
24. IF you were MOVING IN AN AUTOMCBILE or othar vehicle at th: time, then complete the following questions:
24.1 What direction were you moving? (Circle One)
a. North c. East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
CC-2E
26. in order that you can give as clear a picture as possibl 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 saw.
-

when you first saw it. Place a "B" on the compass where you last saw the object.
90
75
! H
O NS
NW
O / 3
C
230
2200
2. Draw a picture that will show the motion that the object or objects made. Placo an "A" at the baginning of the
path, a "B" at the end of the path, and show any changes in direction during the course.

Pag6
30. Have you ever seen this, or a similar object before. If so give dats or dates and location.
31. 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 addressas:
32. Please give the following information about yourself:
NAME
Last Name First Name Middi Name
ADDRESS Cho
City Zone State
TELEPHONE NUMBER AGE sExmal
33. When and to whom did you roport that you had sean the object?
IS Ao 65
Day Month Yeer