PROJECT BLUE BOOK

PROJECT 10073 RECORD ?
1. DATE - TIME GROUP 2 LOCATION
26 Mar 66 27/0136Z Preble County, Ohio
3. SOURCE 10 CONCLUSION
Civilian SATELLITE (ECHO II)
4. NUMBER OF OBJECTS ECHO II North of the city 47 degrees above the horizon
One moving SE
5. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS
Three Minutes Object appeared as a star only moving at a I high rate of
speed.
6. TYPE OF OBSERVATION
Ground-Visual
7. COURSE
Easterly Lasue1ty
8. PHOTOS
0 Yes
No
IDENCE DENCE
Y.s 1
XX No Multiple Reports
FORM
FTD SEP 63 0-329 (TDE) Previous editione of this form may be used. Previous oditione of this form may be used.
,
8
0A .

Page 2
.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 moonlight
Many c. No moonlight - pitch dark 1
d. d. Don't remember
.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 Snow
e. Don't remember
10. The object appeared: (Circle One):
a. Solid d.As a light d.As a light
b. Transparent b. Transparent e. Don't remember
c. Vapor Vapor
If it appeared as a light, was it brighter than the brightest stars? (Circle One): .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 b. Dimmer d. Don't know d. Don't know
11.1 Compare brightness to some common object:
The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright star
c. Sharply outlined
d. Don't remember
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 Ne Don't know
c. Break up into parts 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 No Don't know
g. Flash or flicker? Yes No Don'tknow
h. Disappear and reappear? Yes No Don't know

(Circle One) Yes No
IF you answered YES, then how far away wo
22. Where were you located when you saw the object?
(Circle One):
a. 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?
c. Outdoors Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. 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)
a. North C. East e. South g. West
. Northeast d. Southeast f. Southwest h. Northwest
24.2 How fast were you moving? 50 miles per hour.
24.3 Did you stop at any time while you were looking at the object?
(Circle One) Yes No D
2. Did you observe the object through any of f the following?
a. Eyeglasses Yes No e. Binoculars No
b. Sun glasses Yes No f. Telescope Yes
c. Windshield Yes No g. Theodolite Yes No
d. Window glass Yes No h. Other
In order that you can give as clear a picture as possible of what you saw, describe in your own words a common
like abright star.

Page 3
14. Did the object disappear while you were watching it? If so, how?
%es, slowly faded out.
I+
.
(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: _
. Tell in a few words the following things about the object:
a.Soundun knoien
b. Color White light likeastar.
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? sighting, how much of the object would have been covered by the match head?
Tartically,
Draw a picture that will show the shape of the object or objects. Label and include in your sketch any details
of the object that 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.
- C
-
1

Yes No
31.1 IF you answered YES, did they see the object Circle One) Yes No
31.2 Please Jist tbeir names and addresses:
-Ricbn
Richmond
.Please give the following information about yourself: .Please give the following g information about yourself:
Last Name Name Middls Name
Richmand Richmond Ind
City Zone State
TELEPHIONE NUMB TELEPHONE NUMBER AGE 1 7 AGE 17 SEX M
ditional rience, which might be pertinent.
R6 3 66 MCBlain Police
Day Month Pt1.
Year

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 last saw it. Place an "A"" on the compass
HE
60° 3
45 NW NE
30
E
-15° SW SS
S
path, a "B" ot the end of the path, and show any changes in direction during the course. path, a "B"" ot the end of the path, and show any changes in direction during the course.
A A Faddd B
29. IF there was MORE THAN ONE object, then how many were there? one only
Draw a picture of ho hey were arranged, and put an arrow to show the direction that they were traveling.

This questionnaire has been prepared so that you can give the U.S. Air Force as much
information as pos ncerning the unidentified aerial phenomenon that you have observed.
Please try to ansy y questions as you possibly can. The information that you give will
be used for research 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, e may contact you for further details.
1. When did you see the object? 2. Time of day: 3.5
Hour Minutes
26 Macch 1966 (Circle One): A.M. or P.M.
Day Month Year
3. Time Zone:
(Circle One): a. a. Eastern (Circle One): (. a. Daylight Saving Daylight Saving
b. Central ( .) Standard
c. Mountain
d. d. Pacific Pacific
e. Other
4. Where were you when you saw the object? 4. Where were you when you saw the object?
Preble Preble
Nearast Postal Address City or Town State or County
5.How long was object in sig Total Duration) 4/
Hours Minutes Soconds
a. Certain c.Not very sure
b. Fairly certain d. Just a guess
5.1 How was time in sight determined? N;s T watch
5.2 Was object in sight continuously? Yes Yes No
6. What was the condition of the sky?
DAY NIGHT
a. Bright a.
b. Cloudy Cloudy
(Circle One): a. In front of you d. To your left
b. In back of you e. Overheod
c. To your right 1. Don't remember
FORM
FTD OCT 62 164 This form supersedes FTD 164, Jul 61, which is obsolete.
A

took
we were looking Skyward,
saw it We were Prepo
for objects moving in sky.
Had Telescope, elescope, and
Stillcame ra and motion Picture Camera, ra and Motion Picture Camera,

Page 3
14. Did the object disappear while you were watching it? so, how? /
15. Did the object move behind something at any time, particularly a cloud?
(Circle One): Yes No 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:
0. Sound No soun
Js S 95ian 75ian
We wish to know the angular size. Hold a match stick at arm's length in line with a known object and note how . 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?
mostofit
Draw a picture that will show the shape of the object or objects. Label and include in your sketch any details
of the object that 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.
I coald

Page 2
8IF 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 moonlight
@ Many c. No moonlight - pitch dark
Don't remember d.
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
6 Scattered clouds c. Moderate or heavy rain
Thick or heavy clouds d. Snow
e. Don't remember
10. The object appeared: (Circle One): 10. The object appoared: (Circle One):
a. Solid As a light
b. Transparent Transparent e. Don't remember
c. Vapor
If it appeared as a light, was it brighter than the brightest stars?Circle One): If it appeared as a light, was it brighter than the brightest stars?(Circle One):
a. Brighter About the same
b. Dimmer d. Don't know
11.1 Compare brightness to some common object: common obiect:
Irapes it B: ShighT/BriGHER Tμa"
The edges of the object were:
(Circle One): Fuzzy or blurred e. Other
b. Like a bright star
c. Sharply outlined 1
d. Don't remember
Did the object: (Circle One for each question)
a. Appear to stand still at any time? Yes Don't know
b. Suddenly speed up and rush away at any time? Yes Don't know
c. Break up into parts or explode? Yes Don't know
d. Give off smoke? Yes Don't know
e. Change brightness? Yes Don't know
f. Change shape? Yes Don't know
g. Flash or flicker? Yes Don't know
h. Disappear and reappear? Yes Don't know

(Circle One) Yes (No)
IF you answered YES, then how far away would you say it was?
22. Where were you located Iwhen you saw the object? 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?
6 In a car In open countryside?
c. Outdoors dNear an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea f.
f. Other. g. Other
24. IF you were MOVING IN N AUTOMOBILE or other vehicle at the time, then complete the following questions:
24.1 What direction were you moving? (Circle One)
. North East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
(Circle One) Yos No
25. Did you observe the object through any of the following?
a. Eyeglasses Yes No e. Binoculars (Yes No /
b. Sun glasses f. Telescope Yes No
c. Windshield No g. Theodolite Yes No
d. Window glass Yes (Ng h. Other
2. 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 the sky, would give the same appe earance as the object which you saw.
could
)

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 oncerning the unidentified aerial phenomenon that you have observed.
Please try to answer questions as you possibly can. The information that you give will
be used for research purposes. 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.
When did you see the object? 2. Time of day: 8 36
Hour Minutes
26 3 6o (Circle One): A.M. or P.M.
Day Month Year
3. Time Zone:
PS P5 (Circle One):Ca. (Circle One):Ca. Eastern (Circle One): a. Daylight Saving (Circle One): a._ Daylight Saving 1
b. Central b. Standard
c. c. Mountain
d. Pacific
e. Other
4. Where were you when you saw the object?
PREBLE
Nearest Postal Address D MLAA City or Town Citv or. T State or County State ovr County
(Total Duration) 3
Hours Minutes Soconds
aCartain c. Not very sure
b. Fairly certain d. Just a guess
5.1 How was time in sight determined? BY WATCHES
5.2 Was object in sight continuously? Yes K
6. What was the condition of the sky?
DAY NIGHT
a. Bright
b. Cloudy 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
OC 2 164 FORM
FTD This form supersedes FTD 164, Jul 61, which is obsolete.

Pago 5
.In the following sketch, imagine that you are at the point shown. Place an "A" on the curved line to show how
show how high the object was above the horizon (skyline) when you last saw it. Place an " on the compass
when you first saw it. Place a "B' the compass where you last saw the object.
90° H75
60 $\s3
5
NW NS
30°
E
-15° SW SS
J
28. 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.
13
As
29. IF there was MORE THAN ONE object, then how many were there? _ -
Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.

Page 6
Have you ever seen this, or a similar object before. If so give date or dates and location.
/
Tuesdig 22 March 4:10 P.M 196
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:
dIpd
Fd
Please give the following information about yourself: 32. Please give the following information about yourself:
NAME
Last Name First Name Middle Name
ADDRE Ind
Street Street City Zone State
TELEPHONE TELEPH ONE NU AGE 14 AGE SEX Male
experience, which might be pertinent.
.When and to whom did you report that you had seen the object? F.T.P.
26 March 1466
Day Month Year PlL. McBlain )
WiPHED.

It Lock Like asta move
I+Look tofast

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 questions as you possibly can. The information that you give will
be used for research r 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, may contact you for further details.
.When did you see the object? 2. Time of day: 8 35
Hour Minutes
26th MARCH 1966 (Circle One): A.M. or P.M
Day Month Year
3. Time Zone: /
(Circle One): a Eastern Q. a. Daylight Saving
b. Central Central 6 Standard Standard
c. Mountain
d. Pacific
e. Other
4.Where were you when you saw the object?
. . Preble County Preble County
Nearest Pnstal Address City or Town T State or County Statoe
5.How long was object in sight? (Total Duration) 4
Hours Minutes Seconds
a. Certain c. Not very sure
Fairly certain d.Just a guess
5.1 How was time in sight determined? WRIST WATCH
5.2 Was object in sight continuously? Yes No —
6. What was the condition of the sky?
DAY NIGHT
a. Bright a.
b. Cloudy 6.
7IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object?
1
(Circle One): In front of you d. To your left
b. In back of you e. Overheod
c. To your right f. Don't remember
OC2 164 FORM
FTD This form supersedes FTD 164, Jul 61, which is obsolete.

Page 2
8IF 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
6 A few Dull moonlight
c. Many c. No moonlight - pitch dark
d. Don't remember d.Don't remember
.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 C Snow L-16-HT
e. Don't remember
10. The object appeared: (Circle One): . The object appeared: (Circle One):
a. Solid As a light
b. Transparent e. Don't remember
c. Vapor
If it appeared as a light, was it brighter than the brightest stars? (Circle One): If it appeared as a light, was it brighter than the brightest stars? (Circle One):
a. Brighter About the same About the same
b. Dimmer b. Dimmer d. Don't know
11.1 Compare brightness to some common object:
IT APPEARED SLIGHTY BRIGHTER THAN A STAR,
.The edges of the object were:
(Circle One): a. Fuzzy or blurred Other were No+ visble
b. Like a bright star
c. Sharply outlined /
d. Don't remember
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. Give 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

(Circle One) Yes No
IF you answered YES, then what speed would you estimate?
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 would you say it was? -
22. Where were you located when you saw the object? .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.) In a car In open countryside?
c. Outdoors d. Near an airfield?
In an airplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
Other THEN STOPPEO AND GOTOUT g. Other
24.1 What direction were you moving? (Circle One)
.North c.East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
24.2 How fast were you moving? 50 miles per hour.
(Circle One) Yos No
25. Did you observe the object through any of the following?
a. Eyeglasses Yes No e. Binoculars Yes
b. Sun glasses No f. Telescope Yes
c. Windshield Yes No g. Theodolite Yes
d. Window glass Yes No h. Other
2. In order that you can give as clear a picture as possible of what you saw, describe in your own words a common
SATELITE ABOUT S1ZE.
STAR OR

Yes No
in front of: Gunty thn ehang in harion we zained distaner
C
17. Tell in a few words the following things about the object: LI61+T
ar Sound 310 wou ?-
b. Color sSacsld red likna stipligef Ale
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
amall
(5)2 also think th nd tast

IF you answered YES, then how far away would you say it was? p
grod?
22. Where were you located when you saw the object? 2. 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. In a car In open countryside?
c. Outdoors d. Near an airfield?
d.In an airplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. g. Other
4IF you were MOVING AUTOMOBILE or other vehicle at time, then complete the following questions:
24.1 What direction were you moving? (Circle One)
a. North c. East e. South g. West
Northeast eha d. Southeast f. Southwest h. Northwest
towandooodvell,
24.2 How fast were you moving? 2int 5miles per hour.
thi ear.a4
tine the tuates so it wonid. wnissus, did ther it
stippd aroend to the wile of the war

show how high the object was above the horizon (skyline) when
when you first saw it. Place a "B"
90° 75°
60
45
30
E
-15° 3W
35
S
Texhoma
o
path, a "B" at the end of the path, and shuw sny changes in direction during the course.
Gooduellec
well.
A 10.

Page 6
Have you ever seen this, or a similar object before. If so give date or dates and location.
life lik 7
this.
3. Was anyone else with you at the time you saw the object? (Circle One) Yes No
1 Yes) No
ddresses:
Lileral, Kansas 67901
NAME Last Name First Nome Middla Name
ADDRESS fileral
City Zone State
TELEPHONE NU AGE28 SEX female
experience which miaht be pertinent.
auj ew gif forthian,
wiling uenesnet that was sick unotiad
When and to whom did you report that you had seen the object?
27 Mach 1966 whocth after sig litid, early in the
Month Year A.M. O
Day petul,
T

Page 3
14. Did the object disappear while you were watching it? If so, how?
yES, at suemed to fade ont
.
Did the object move behind something at any time particularly a cloud?
(Circle One): Yes ND Don't Know. IF you answered YES, then tell what I
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. Soundno
b. Color sntite ligh't lie a stan
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 hgve been covered by_ the match head?
Draw a picturs that will show the shape of the object or objects. Label and include in your sketch any details
of the object that 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.
twashailwkite

on a
Ctherwise why ivea
talking would terns in such
er case, 321 wre err both ofrüd
and
we were watehig ond the lights, Eegept
for the park lights, so thad it wouldn'
do something to
us.
,

you complete the attached FTD Form 164 and return 2
it in the envelope provided.
4
We wish to thank you for reporting your observation
to the Air Force.
2
DE CIIY Sincerely,
.
DSH.Perh

27 March 1966. The information which we have re- in
ceived is not sufficient for evaluation. Request
you complete the attached FTD Form 164 and return
it in the envelope provided.
We wish to thank you fof reporting your observation
to the Air Force.
OD FI B Sincerely,
N.DHBuh
HECTOR QUINTANILLA, Jr, MajOr, USAF O
Chdet p. &oe+
P

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 a. Bright moonlight
b. A few b. Dull moonlight
c. Many .c. No moonlight - pitch dark
d. d. Don't remember
9. What were
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky Ca Dry
Hazy b. Fog, mist, or light rain
c. Scattered cloud c. Moderate or heavy rain
Thick or heavy clouds d. Snow
e. Don't remember
10. The object appeared: (Circle One): 10. The object appeared: (Circle One):
a. Solid d. As a light
b. Transparent Transparent e. Don't remember . Don't remember
c. Vapor
If it appeared as a light, was it brighter than the brightest stars? (Circle One): I t appeared as a light, was it brighter than the brightest starsCircle ne):
a. Brighter Brighter C. About the same c. About the same
b. Dimmer b. Dimmer d. Don't know d. Don't know
11.1 Compare brightness to some common object:
Ld
.The edges of the object were: ~
(Circle One): a. Fuzzy or blurred e. Other
Like a bright star
c. Sharply outlined 1
d. Don't remember
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. Give 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 Ne Don't knaw )
h. Disappear and reappear? Yes Don't know

2Do you think you can estimate the speed of the object?
(Circle One) Yes No
(Circle One) Yes No
IF you answered ES, then how far away would you say it was?
2. Where were you located when you saw the object? Were you (Circle One)
(Circle One):
aIn the business section of a city?
a. Inside a building b. In the residential section of a city?
b.In a car In open countryside?
c. Outdoors d. Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea f. Flying over open country?
f. g. Other
24.1 What direction were you moving? ircle One)
a. North C. East e. South g. West
b. Northeast d. Southeast f. Southwest h. Northwest
object or objeçts placed up in the sky, would give the same ap
Juat ery bright 22 nt

Page 5
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 last saw it. Place an "A" on the compass
90°
A75-
60° B
NW N5\
E
15° SW 55
S
path, a "B" at the end of the path, and show any changes in direction during the course. path, a"B" end of the path, and show any changes in direction during the course.
Kstopd stped itp2V itpe
A A B
IF there was MORE THAN ONE object, then how many were there?
Draw a picture of ho ey were arranged, and put an arrow to show the direction that they were traveling.

remberth dates of these.
I
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:
HIL DR, RICHM JUD
32. Please give the following information about yourself: 32. Please give the following information about yourself:
NAME
Last Namo Last Name First Name Middlo Name Middle Name
ADDRESS TERVILLE ERVILLE IND
Street City Zone State
TELEPHONE TELEPHONE NUMBER NUMBE AGE 18 SEX SEX MALE
-
,
.When and to whom did you report that you had seen the object? PTL. MBLAIN
2-6 3 66 W.P.A.F.B
Day Month Year √

Page 7
34. Date you completed this questionnaire: 26 3 66
Month /
Day Year
Inforatin which yu e pertnent nd which s  adequat covedin  spec points of e
questionnaire or a narrative explanation of your sighting.
TODK MOVIES
i
I80
,

. .
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 questions as you possibly can. The information that you give will
be used for research rposes.
conclusions, or publications s without your permission. We request this personal information so
that if it is deemed neces may contact you for further details.
When did you see the object? Time of day: 8 3S
Hour Minutes
2.6 3 66 (Circle One):
A.M. or P.M.
Day Month Year
3. Time Zone:
(Circle One): (Circle One):Ca. a. Eastern (Circle One): a. Daylight Saving (Circle One): a. Daylight Saving
b. Central Standard Standard
c. Mountain
d. Pacific Pacific
e. Other
4. Where were you when you saw the object? 4. Where were you when you saw the object?
Trelole Co. Trelole Co.
Nearest Postal Address City or Town State or County State or County
5. How long was object in sight? (Total Duration) 3
Hours Minutes Seconds
a. Certain c. Not very sure
b. Fairly certain d. Just a guess
5.1 How was time in sight determined? BU Wutahes
5.2 Was object in sight continuously? Yes it No
6. What was the condition of the sky?
DAY NIGHT
a. Bright
b. Cloudy Cloudy
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. Overheod
c. To your right f. Don't remember
OCT 62 164 FORM
FTD This form supersedes FTD 164, Jul 61, which is obsolete.