PROJECT BLUE BOOK

PROJECT 10073 RECORD
1. DATE • TIME GROUP LOCATION
Jan. 66 0220Z Poulsbo, Washington
3. SOURCE 10. CONCLUSION Pirectors
Civilian Insufficient Data
Merpspace Studies 243,6
4. NUMBER OF OBJECTS Maswell ArB, Alcpoma ATn: rchives Biunch
RETURN1
N/A
S. LENGTH OF OBSERVATION BSERVATION T1. BRIEF SUMMARY AND ANALYSIS Inst O
8-10 Minutes 8-10 Minutes ma
Cbserver not sure of data Cbserver not sure of data and how many ohjects there
6. TYPE OF OBSERVATION were. were. Object/s shot straight up then disappeared
Ground Visual to the south. Also conihictihg data.
1
7. COURSE 2
To the South Dota Or
8. PHOTOS Valuation man{
for be persoud persoua
Yes Needed would would a
8 No 80 No uot! adust
9. PHYSICAL EVIDENCE but I would
luTevui aul protohlit
Yes low
C No
FORM B geitius sufficient
FTD SEP 63 0-329 (TDE) Previous edidons of this form may be used.

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4 32
sgnialy
alighlor Resbeitfully
Poulsha, Washingten 98370

OU L S8 E
Poulibo, Poulibo, HAR 31
Hhingn Hhingen 1965 1966
WASY WAS
Projet Biuve Bok Afmetin Projet Blue Book nfamati
SAFOI
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26330
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U.S. AIR FORCE TECHNICAL INFORMATION
This questionnaire been prepared so that you can give the U.S. Air Force as much
information as possible ncerning the unidentified gerial phenomenon that you have observed.
Ploase try to answer as estions as you possibly can. The information that you give will
be used for research ur name will not 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.
1. When did you see the object? 2.Time of day:. 1.0
Hour Minutes
onaSated Pay 1966
(Circle One): A.M. or P.M.
Day Month Year
. Time Zone:
(Circle One): Eastern (Circle One): a. Daylight Saving
b. Central b.Standard
c. Mountain
d.Pacific
e. Orher
4. Whers wers you when you saw the object?
Kx Paulsho Paulsho Clask
Nearest Postal Address City or Town Stato or County
5. How long was object in sight? (Total Duration) 8cton
Hours Minutes Seconds
a. Certain c. Not very sure
b. Fairly certain d. Just a guess
5.1 How was time in sight determined? saleay hien fort
5.2 Was object in sight continuously? Yes No-—
6. What was the condition of the sky?
DAY -NIGHT Corlf
Bright a. Bright
b. o. 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 . Overheod N
c. To your right f. Don't remember
162 164 CM
This form aupersedea FTD I64, Jui 61. which in obsclete.

Page 2
8.1 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 a. Bright moonlight
b. A few - b. Dull noonlight
c Many c. No moonlight - pitch dark
d. 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 b.Fog, mist, or light rain
c. Scattered clouds c. Moderate or heavy rain
d. Thick or heavy clouds erneays d. Snow
e. Don't remember Don't remember
10. The abject appeared: (Circle One):
a. Solid a. Solid d.As a light d. As a light
b. Transporent b. Transparent e. Don't remember
c. c. Vapor
11. If it appeared as a light, was it brighter than the brightest stars? (Circle One): 1. If it cppeared as a light, was it brighter than the brightest stars? (Circle One):
a. Brighter c. About the same
b. Dimmer dDon't know
1l.1 Compare brightness to some common object:
Differnthind ofadight Coalesant Jbelie
12. The edges of the object were:
(Circle One): a. Fuzzy or blurred o. ther Tchie ligh be re li ht
b. Like a bright star
c. Sharply outlined
d. Don't remember 4122
13. 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 purts or explode? Yes No Don't know
d. Give off smoke? Yes No Don't know
e. Change brightness? Yes No) Don't know
f. Change shape? Yes CNoy Don't know
g. Flash or flicker? (Yes No Don't know /
h. Disappear and reappear? Yes №\sqrt}$ Don't know

Paga 3
14. Did the object disappear while you were watching it? if so, how?7 meuff8u
L4err
bhc sree etrar
Meaely struight loniths.
15. Did the object 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: -
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:
a. Sound2242
bit
18. Wa 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

Crrcle One) Yes No
C 42
IF you ansyered YEs, then how far away would you say it was?
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. 1 In a car c. In open countryside?
c. Outdoors d. Near an airfield?
d. I In an airplane (type) . Flying over a city?
e. At sea Flying over open country?
f. Other_ g. Other
24. IF you were MOVING IN AN AUTOMOBiLE or ather vehicle at the 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. d. Southeast f. Southwest f. Southwest h. Northwest 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 No Binoculars Yes No
b. Sun glasses Telescope Yes No
c. Windshield Yes No g. Theodolite No
d. Window glass Yes No h. Other
26. In order that you can 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 ths sky, would give the same appearance as the object which you saw.

29
Pag 5
.In the following skatch, imagine that you ara at the point shown. Place an "A on the curved line to show how
high the object was above the horizon (skyline) whan you first saw it. Placs a "B" on the some curvad line to
show how high the object was above tho horizon (skylina) when you last saw it. Place an " an ths compass
whan you first saw it. Place a "B" on the compass whers you last saw the objoct.
60
NW NS
E
15 3W
35
5
. Draw a picture that will show the motion that the object or objects made. Placo an "A" at the beginning of th
path, a "B' at the end of the path, and shuw any changes in direction during the course.
Miiriy Ttiigtt iep cnd tterone
Dirit
55

Pago6
30. Have you ever seen this, or a similar object before. If so give date or dates and location.
M20l
31. Was anyone else with you at the time you saw the object? (Circle One) Y^s 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: :
n -
ASk
32. Please give the following information about yourself:
NAME
Last Na First Name
ADDRESS Pousbo Lsh
Str City Zone Store
TELEPHONE NUMBE AGE 54 sexlnale
33. When and to whom did you report that you had seen th object?
1042
Day Month Year

Din mly
Theando

Poulsbo, Washington 98370
Dear Mr
Rsferencs your recent unidanti fied obsarvation in Joruary 1966.
The informrtion in your letter of 3C March i9sé wrs not suffi- C
cient for evaluation. Request you complete the attached FTD
Form ló4 and return it in the envelope provided.
We wish to thankyou for reporting your observation to the Air
Force.
B
Sincerely,
I WM