PROJECT BLUE BOOK

PROJECT 1073 PECORD
DATE' TIME GROUP 2. LOCATION
5 Nov 66 5/0435z Dayton, Ohio (multiple)
3. SOURCE 1. CONCLUSION
Civilian (other) INSUF IC:  DAA FOR EVALUATION
1. NUMBER OF OBJECTS
One
5. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYS:S
50 minutes 'SEE CASE
.. TYPE OF OBSERVATION
Ground Visual

cee
.

| 1. DATE - TIME GROUP |
' 7 Nove 46 1030Z

3. SOURCE
Civilian
EE

| 4. NUMBER OF OBJECTS

7S eS SS SS"

11. BRIEF SUMMARY AND ANALYSIS

5. LENGTH OF OBSERVATION
' few seconds

re TYPE OF OBSERVATION

Ground Visual

7. COURSE

soutneastward

8. PHOTOS

5B Yes

9. PHYSICAL EVIDENCE

FORM

~OCATION

PROJES. ivu/3 RECOKS

way.on, Onio one witness

————$ -$— —————— — _ - ——_

10. CONCLUSION
Astroymeteor)

Cboserver watched a fuzzy or diurred object travel to-
ward the southeast at about tten minutc’ intervals.

The color was like a blue glowing light, like an
electric arc. ‘The objects went down like the sun but
very fest. The objects flew in an eastern direction
2% @ high rate of speed in a straight line. The
observer only saw one in full view, tac rest of them
were just a blue arc. All of tnex dic not come in the
same direction.

Tne description is consistent with that of an astro-
nomical odservation(meteon)

FTD sep 63 0-329 (TDE) Previous editions of thie form may be used.

ee ee ee ee ee ee

—— _—

ooo se

U.S. AiR FORCE TECHNICAL INFORMATION

This questionnaire has been prepared so that you can yive the U.S. Air Force as much
information as possible concerning the unidentified aerial phenomenon that you have ol served.
Please try to answer as many questions as you possibly can, The information that ycu give wil!
be used for research purposes. Your name will not be used in connaction with any statemenis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed necessary, we may contact you for further details.

1. When did you see the object?

Z £eoVvewler 17
ee re Re ee a On as a ae | E<. de =

Day

3. Time Zone:

(Circle One): (a, Eastern:
b. Central

¢. Mountain

d. Pacific

e. Other

{Curcle One): A.M. or

(Circle One): a. Daylight $6 "tne,

(b» Standard

4. Where were you when you saw the object?

vo —_-— P a /

f — / / j

J. a” ‘ ‘ / ‘ J ‘
- _— _ aa - ~--

ecrest Postal Address

a, Certain
b. Fairly certain

5.1 How was time in sight determined?

5.2 Wos object in sight continuously?

6. What was the condition of the sky?

DAY
a. Bright
b. Cloudy

5. How long was object in sight? (Total Duration)

City or Town

Minutes

Hours Minutes Seconds

c. Not very sure

(4,) Just o guess

| re

—_— — ae —_— + --hUl Cr

No x.

NIGHT

(a) Bright

b. Cloudy

PM.

Stotea w County

7 IF you sow the object during DAYLIGHT, where was the SUN loccted os you locked 2! the object?

(Circle One); a, In front of you
b. In back of you
¢. To your right

FORM
FTD ocr 62 164

d. To your left
e, Overhead

f, Don’t remember

Thi» form supersedes FTD 164, Jul 61, which is obsolete.

8. IF you saw the object of NIGHT, what did you notice concerning the STARS and MOON?

B.1 STARS (Circle One): 8.2 MOON (Circle One):

a. None a. Bright moonlight
b. A few b. Dull moonlight
c. Many ¢. No moonlight — pitch dark

d. Don't remember

ww. = + ee ee

d. Don’t remember

con -—o-eo- oOo Orr +

9. What were tie weather conditions at the time you saw the object?

CLOUDS (Circle One): WEATHER (Circle One):
(a. Clear sky @,; Ory

b. Hazy b. Fog, mist, of Sight roin
c. Scattered clouds ¢. Moderote or heavy rain
d. Thick ot heavy clouds d, Snow

e. Don’? remember

—— ee oo o* — ES SS

——— =

10. The object appeared: (Circle One).

@) Solid d. Asc 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 some

~~"

b. Dimmer d. Don’: know

11.1 Compare brightness to some common object:

-—- - ——- —— ——-~ - ——— - —- -—- --——

we ee

12. The edges of the object were:

(Ciclo Une) (a.. Furry of blurred e. Other
» Like a bright stor _—

c. Sharply outlined

d. Don’t remember

_— Fe we me ee ’ ~ ee OO ae ee enn 9 SS ee ine

13. Did the object:

a. Appear to stand still at any time? Yes ‘No.
b. Suddenly speed up ond rush away at any time? Yes “No.
c. Break up into parts or explode? Yes ‘No-
d. Give off smoke? Yos No
e. Change brightness? Yos No
f, Change shape? Yes No
(g- Flash or flicker? ‘Yes No
h., Disappear and reappear? Yes No

—— ———_—

(Circle One for each question)

Don’t know
Don’t know
Don’t know
Don’t know
Don’t know

Don’t know
Don’t know

Deon’? know

Page 2

15.

16.

———
se
ad '

=) Pe ae Seon _

—— os
—

a = _* atl * i — Tr
al . > - a 4 =
A Ae A le A le ee Nl LL NG it te me me

Puge 3

14. Did the object disappear while you were vatching it? If so, how?

7.

18,

19.

ral i f Loy ra . P - . ie oe E nae eo hi
“eee eager Pek a AQUM.. ER A A A OS ee Ee |
Did the object move behind something at any time, porticulurly a cloud?
(Circle One): Yes (No) Don’t Know, IF you snswered YES, then tell what

it moved behind: . ........- ,—i«i(t. a et ey a) | ae
Did the objeet move in front of samething at any time, particularly a cloud? |
(Circle One): Yes (Ng Don’t Know. IF you answered YES, than te!! wiist

a ata earns Rr tae, 9c 5. en i at alc, AER on Sst | AE 2- dn Cnn, MN nmtN a, ste MEM:

sil a aie ibis ieiate dace hii ei aa cir heehee maa ik ai cok nae: Mable nae ads beans | sine Hiss wen wee ere a piiwecusws os -a< ss {
Tell in a few words the following things about the object:
3 \

a. Sound 49.4 €

——— Hoe ——— « oa ee ee ee —-- - — . =

b. Color Glue Glawrng f/pfe Likeaw efecTrit OG7Ch. ...

a ae ee ee

ee ee er ete

We wish to know the angular size. Hold a match stick at arm's length in line with a known cbject and uz! "an
much of the object is covered by the head of the match. If you had performed this experiment at the tirw: of sts
sighting, how much of the object would have been covered by the match head? |

— —_—_—_— —_- oO re r- + r - —_ ae Owes eee eae -_

Draw a picture that will show the shape of the object or objects. Label and include in your sketch any datoils
of the object that you saw ‘such as wings, protrusions, etc., and especially exhaust trails or vapor trails.

Place on arrow beside the drawing to show the direction the object was moving.

eer aaa ian eee nee
20. Do you think you can estimate the speed of the object?

(Circle One) Yes No. |
IF you answered YES, then what speed would you estimate? tk. = 4

— — ——_— - ee oro Cc + + + —_~—- + —

-—— + — —_— ee eee eee ee a + ee

21. Do you think you can estimate how far away from you the object was?

(Circle One) (Yes ‘\ No f tif J Al
al Pal £ and th hg A |
IF you answered YES, then how far away would you say iz was? \/ NEO LL fer d |
sti ee ee
22. Where were you located when you saw the object? 23. Were you (Circle One)

(Circle One):
a. ir: the business section of a city?

o, Inside a building b,) In the residential section oi o city?

b. Ina car c. In open countryside?
4 (© Outdoors (d.) Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea f, Flying over open country?
f. Other Be oom wi | Lee ae ea ne eae ee

—_o-ooOo_--:-::--:--:-:-: ee + - c--  ----- —

a

5. nk 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 y. West
b. Northeast d. Southeast f, Southwest 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?
q @.) Eyeglasses Yes No e. Binoculars Yes No — |
. b. Sun glasses Yes No f. Telescope Yes No |
c. Windshield Yes No g- Theodolite Yes No |
i d. Window glass Yes No h. Other a e Fee a et )

4 y — —— —_—— ————— Se ee Oe

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 the sky, would give the same appearance as the object which you sow

. *
ta
—"s - : . 7 -?- 7h if f :
ef Pg é rH, “ : ‘/ : “ | 39 63 P , L EAC LU ,
Lhe tage of Lhp ottecl wren 4 Remon 2 dh OMAN CHEE
PS os FP, , = . ot, & —-t- -
‘a w ,
D /
) ’ bi_f s “ 4Pt “7 2-L-77 | MAD o~ A eee
SLL _—* fret ALo “ + cual p f-—~ ~ oT

a

fegee

27, In the following sketch, imegine thet you are at the point shown, Place un ‘‘4."’ on the curver line to show how
high the object was above the horizon (skyline) when ycu first sew It. Place 9 ‘'B’’ on the same curved fine ir.

show how high the object wos above the horizon (skyline) when you Jast suw it, Place an ‘’A” on the compass
when you firs? sow it, Ploce o ''8'’ on the compass where you Jost saw the object,

75°

90°

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 ‘'8"* ct the end of the poth, and show any changes in direction during the course.

Wr flew pe Laws pehelite wlercetlitr~ 27 Cee High fre of aprccok

ut as AM AGhS Ze

29, IF there was MORE THAN ONE object, then how mony were there? Ziat a
Draw a picture of how they were orranged, and put an arrow to show the direction that they were traveling.

‘4 LAS onky OFCL a fl -VUiw~ , tf het’ of ae
yy ue
ivtti fH ad Cr ya ce ae CLC of yen pt ae a
C7e ae Lracgy ft evo  .

SOWIE.

Fage 6

| 30. Have you aver sean this, or a similar objsct befora, |f 30 give dara or datys and location. |

7)

f ’

31. Was anyone else 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 end addresses:

32. Please give the following infermation about yourself;
i : :
ee Le ? U Cu . a” } a, v f
os het AAAS LO. APA
Stree? i City Zone State

TELE PHONE ce 0 Ce ae SEX =

indicate any additional information about yourself, including any special experience, which might be pertinenr.

33. When and to whom did you report that you had seen the object?
és 7 ps 3
Day Month Yeor

4

Page 7

|

, 34, Dates you completed this questionnaire: Toleaee : [ae acerca A wees
: Day Month Year

_ 35. Information which you feel pertinent and which is not adequately covered in the specific points of the
questionnaire or a narrative explanation of your sighting.

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 onswer as many questions as you possibly can, The information that ycu give will
be used for research purposes. Your name will nof be used in connection with any statemenis,
conclusions, or publications without your permission. We request this personal information se
that if it is deemed necessary, we may contact you for further details. f

1. When did you see the object? 2. Time of day) —&

tioue Minutes

/ Ney i ~
ee ee , x MA... _ t tL {Circle One): A.M. or P.M.
Day Month Yeur am

3. Time Zone: es

}. (Circle One): ox Eastem — (Circle One); 0. Doylight Sc-ing

<b. Standard,
c. Mountain ~ Ser nad

2 = —

d. Pacific | |
| e. Other —

4. Where ware you when you saw the object?

—_— eee a

Neorest Postal Address City or Town 3

i iste ,
“4 oF 40 Seu” aJs® euniess eS

Minutes Seconds

5. How long was object in sight? (Total Duration)

——— one

——— , . ="
| ——@, Certain — c. Not very sure
im) —

b. Fairly certain d. Justo guess

5.1 How was time in sight determined?

: 5.2 Was object in sight continuously?

6. Wheat was the condition of the sky?

- ————— ee HF

| DAY—s. C NIGHT > FEI, Lidia *
— | a, Bright _ a, Bright
_ “bp, Cloudy b. Cloudy

4 '

: ‘

ee ee '
}

7. IF you sow the object during DAYLIGHT, where was the SUN loccted as you locked at the object?

{ (Circle One); a, In front of you d. To your left |
a b, In bock. of you e. Overhead :
<  __ To your right > f, Don’t remember |

c FORM |

FTD ocr 62 164

This form supersedes FTD 154, jul 61, which is obsolete.

wep (roerr) 7Uf
Wright-Patterson AFB, Ohio 45433

9 November 1966

} ins Cory
TA?

40) OTE ryEWaEy Whe of Gis

Dayton : oa. 45406

Dear Myguuiaall>

Reference your unidentified observation of 5 November 1966.
The. information which we have received is not sufficient for ~

y
wis

TDE

ase 373 *3 2

: ‘evaluation. © Request you complete the attached FID Form 164
_ * and return it in the ver provided.
5 a?
J | We wish to unk you for reporting your Scbservation to the
| : | Air. Force. — F ,
1 ? |
4 | 1 Sincerely, ~ :
: ae
QUINTANILLA, Jr, Major, USAF

hief, Project Blue Book™ = 0

Ss ee ge et es
: iy ee ek a Pies “er
| : et . . Pat ; = ? :
4 a r
y
A

Poge 2

———

8. IF you saw the object of NIGHT, what did you notice concerming 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 i
c. Many ¢. No moonlight ~ pitch derk

d. Don't remember

ee ee

d. Don't romember

9. What were tie weather conditions at the time you saw the object?

CLOUDS (Circle One): WEATHER (Circle One):
<9 Clear sky a, Ory

“b. Hazy b. Fog, mist, of light rain

c. Scattered clouds c. Moderate or heavy rain

d. Thick ot heavy clouds d. Snow

e. Don’t remember

—— ee he eee

—~—ee ee

~~ ee

—_—~_~-- -

10. The object appeared: (Circle One). Széer ee AR ¢

ceed As An
oo: Solid d. Aso light
b. Transparent e. Don’t remember
c. Vapor

11. If it appeored o8 a light, was it brighter than the brightest stars? (Circle One):

o- - ite:
Brighter ~~" c. About the same
d. Don’: know

. Dimmer

he
~ a,

11.1 Compare brightness to some common object:
_ “— ELECTRiL ae

_— Pri ©

12. The edges of the object were:

(Cucleo Gre) a, Fuzzy of blurred e. Other ec
b, Like a bei tor <nititemeia ene ear ee
4 al Sharply y outlined > eceaelleeigame aeniiscniomaiammnia sea
| . Don’t remember -— aannianl ae eS
13. Did the object: (Circle One for each question)
* a. Appear to stand still at any time? Yes ‘No Don’t know
f b. Suddenly speed up and rush away at any time? Yos |No| Don't know
- c. Break up into parts or explode? Yes ' No: Don’t know
jf d. Give off smoke? Yes No | Don't know
a e, Change brightness? Yes No | Don’? know
i f, Change shape? Yes \No/ Don't know
| as Flash of flicker? Yea” No Don't know
h., Disappear and reappear? Yes No’ Don’t know

Pugs 3

14. Did the object disappear while you were satching it? {1 so, how?

| “ad pee 4
ri ple tgek
15. Did the object move behind something at any time, particularly a cloud?
(Circle One): Yes No Don’t Know. IF you snswered YES, then tell what
: it moved behind; . .._.. ____ . ia: ee ee pee A reety | ee Ca
16. Did the objeet move in front of samething at any time, particularly a cloud? ie
(Circle One): Yes ¢ “No: Don't Know. IF you answered YES, then tat! wisest |
in front of: _ cl eee ae a a ee a a nee |
its deacon ey I cial a gels acreage waves ee rh teres
_o a a ae ie i a ieee ae ee ee ne ae
17. . Tell in a few words the following things about the object: )
3
a, Sound AZ ©. Spent wissndic a ee ee a eat ees a
: >) sop -\ A. ey <=
| b. Color _ on whebhte fe tt : ‘i : cae siete ree dae”
4 18. We wish to know the angular size. Hold a match stick at arm’s length in line with a known object and uct ‘ow
much of the object is covered by the head of the match. If you had performed this experiment at the tire: uf the
sighting, how much of the object would have been covered by the match head?
- Se eHrrd G
. Ps cis (4 ?
LOCLED Lhe oe be

A eereetlieetmeerneeeedttiatitatietinmeneentittteten cette tetera ——

m+ -e Yr OoOr Orr - - -- ——— _—- ——_—_—_—— —— 7

19. 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.

= «>

¥ " =

20. Do you think you can estimate the speed of the object?

(Circle One) Yes /No /

‘ - a

IF you answered YES, then what speed would you estimate?

———— ——_ -— ————— —-— ——-—<—~ SSC OCC Orr Or OOS

—— _ ——ere—— oe

eee ae

21. Do you think you can estimate how far away from you the object was?

(Circle One) Aes 7 No JOO f
my Ay 4 ” Le Ge a7

——_——- ee mn ee ee

IF you answered YES, then how far away would you say it was?

ee —_— ae

22. Where were you located when you saw the object? 23. Were you (Circle One)
(Circle One):

i eileen” a. ir: the business section of o city?
einai a building _ CO be cthe residential section ci o city?

Ina car c. 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?
{, Other __ — 6 RRO aan meer iis iniel Sachibcatoinicin lensed
saeene a et Sear Ee oe ait ee ‘ a

24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions:

24.1 What direction wers you moving? (Circle One)

a. North c. East e. South y. West
b. Northeast d. Southeast f, Southwest 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 Yos No e. Binoculors Yes No
b. Sun glasses Yes No f. Telescope Yes No
_¢. Windshield Yes No g. Theodolite Yes No
~ 2 Window gloss Yes No h. Other — sii img

—_— ——_—__--—_- _—_—--- LLL Le

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 the sky, would give the same appearance as the object which you saw

a % f
~~ Cf ;£
17) he hw

A
path, a "B" at the end of the path, and show any changes in direction during the course.
from hrigon-to honigon
10 O
29. IF there was MORE THAN ONE obloct, then how many were there? _
Draw a plcture of how they were arranged, and put an arrow to show the direction that thoy ware traveling.
10 minite ilengal.
.
*

Jage 6
30. Have you aver seen this, or a similar objoct bofore. If so give date or dates and location.
No 7
Yes EN\o
31.1 IF you answered YES, did they sea the object Circls One) Yes No
31.2 Please list their names end addrosses:
1 COUINETON. KY.
16 m
32. Please give the following Infermation about yourself: . Please give the following infermation about yourself:
NAME
Last Name Last Name Middis Name Middio Name
ADDRESS DAYTON Dhi0 DhT
City Zone State
TELEPHONE NUMBER AGE 21 SEXM
Indicate al experiance, which might bo pertinent.
When and to whom did you report that you had sean the object? When and to whom did you report that you had seen the object?
6NO1 Nod 66
Day Day Month Yoar Year
D.O.FTD Do FTD

-
Pago 7
34. Date you comple restionnaire:
Day Month
questionnaire or a narrativs explanation of your sighting.
1

.
8 November 66
Contact was madewith Wright Pattersen AFB operations to see
if any aircraft were departing the base. The following was
obtained from the base operations personnel:
T-38 departed 1132z 6 Not,
C119 1006z
T-1A (Navy) 1012Z
DC-6 (Log-Air) 1035Z
They had no record of any SAC aircraft departing the base at
the time of the sighting. the time of the sighting.

,
1. DATE · TIME GROUP 2. LOCATION 71
11 November 66 12/0330Z Dayton, Ohio (2 Witnesses)
3. SOURCE 10. CONCLUSION 1. CONCLUSION
Civilian Civilian Possible Possible Aircraft geit geit
4. NUMBER OF OBJECTS NUMBER OF OBJECTS = == juate wate
One
5. LENGTH OF LENGTH OF OBSERVATION OBSERVATION 11. 11. BRIEF SUMMARY AND ANALYSIS
5 Minutes Observer reported Observer reported star like object traveling star like object traveling toward the NE. toward the NE.
6. TYPE OF OBSERVATION Observer first thought light was a plane landing, but finally
realized that it was not getting any closer to the ground.
Ground-Visual Object faded from view almost directly overhead.
7. COURSE Description is consistent with that of a satellite.o.a
AIRCRAFT WITh LONdN LihTS c.
NE
8. PHOTOS
Yes
XNo
2. PHYSICA EVIDENCE
Yes
XNo
FORM
FTD SEP 63 0-329 (TDE) Prevlous editlona of thle form may be ueed.
9 3
.

. :
U.S. AIR FORCE TECHNICAL. INFORMATION
This questionnaire has baan prepared so that you can give the U.S. Air Force as much
information as possible concerning the unidentified aerial phenoinenon that you havu ol serveri.
Please try to answer as many y questions as you possibly can. The information that ycu give will
be used for research purposes. Your name will not be usod in connaction with any statonienis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed necessary, we may contact you for further details.
1. When did you soe the object? ?. fime of da 10 30
Hour Minutas
11 11 66 iCircle One): A.M. or P.M.
Day Month Your Your
.Time Zone:
(Circle One): Eastern (Circla Une): a. Doylight Souing Daylight Soving
b. Contral b. Standard Standard
c. Mountain
d. Pacific
. Other
4. Where were you when you saw the object?
Dayton Ohio
Nearest Postal Address City or Town State or County
(Total Duration) 5
Hours Minutes Saconds
a. Cortain c. Not very sure
Fairly certain d.Just a guess
5.1 How was time in sight determined? estimated
5.2 Was object in sight continuously? Yes No _-
6. Whar was the condition of the sky? 6. Whar was the condition of the sky?
DAY DAY NIGHT NIGHT
a. a. Bright Q. Q. Bright
b. Cloudy b. b. Cloudy
7.IF you sow the object during DAYLIGHT, where was the SUN located as you locked at the obiast? 7. IF you sow the object during DAYLIGHT, where was the SUN located as you locked a: the obiost?
(Circle One): a. In front of you (Circl One): a. In front of you d. To your laft
b. In bock of you . Overheod
c. To your right f. Don't remember
FORM
FTD OCT 62 164 Thie form suparssdes PTD 164, Jul 61, which is obaolete.
.

Pogy 2
8.1 STAKs (ircle Ono): 8.2 MOON (Circle One):
a. None a. Bright moonlight
b. A few b. Dull moonlight
c. Many No moonlight - pitch dork
d. Don't romember d.Don't remember
. What were tine weather cond
CLOUDS (Circle One): WEATHER (Circle One):
a.Clear sky o$ Dry
b. Hazy b. Fog, mist, or light rain
c. Scalrernd clouds c. Moderate ar heavy rain
d. Thick on hoory clouds d. Snow
•. Don't remomber
. The objact appeared:
o. Solid A As a light
b. Tronspoiont Don't remember
Brighter .About the same
b. Dimmer d. Don't know
11.1 Compars brightness to some common oblect:
The landing light of commercial plane about to land.
12. The adges oi the object wore:
(Cuclo(na) a. Fuzzy or blurred . Other
b. Like a bright stor
C. Sharply outlined
d. Don't remember
. Did the object: Did the oblect: (Circle One for each question) (Circle One for eoch question)
2
a. Appear to stand still at any time? Appear to stand still at amy time? Yes No Don't know
b. Suddanly speed up and rush away at any time? Suddenly speed up and rush away at any time? Yes No Don't know Don't know
c. Break up into parts or explode? Break up into parts or explodo? Yes No Don't know
d. d. Give off smoke? Yes No Don'tknow
. Change brightness? Yes No Don't know
f. Change shape? Yes No Don't know
g. g. Flash or flicker? Yas No Don't know
h. Disappear and reappear? Yas No Don't know
1

U.S. AIR FORCE TECHNICAL I INFORMATION
This questionnaire has beon prepared so that you can yive the U.S. Air Force as much
information as possible concerning tha unidontified aerial phanoinenon that you havu observei.
Please try to answer questlons as you possibly can. The information that ycu givs will
be used for research name will not be used in connection with any staterienis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed necessary, we may contact you for further details.
1. When did you see the objoct? 2. Time of da. 35
$2{30$ Minutea
C5 C5 Nor 1966 1966 (Circle One): A.M. or P.M. P.M.
Day Month Yeur
3. Time Zone:
(Circle One): a. a. Eastern Eastarn (Circle Une): (Circle One): a. Daylight So.ing a. Daylight So.ing
5. 5. Contral b.Standard,
c. Mountain
d. Pacific
. •. Other
4. Whore were you when you saw the objoct?
DAYTON 6 O410.
Nearest Postal Address City or Town State or County
5. How long was object in sig Total Duration)
Hours Minutes Seconds
CoCertain c. Not very sure
.Fairly certain d. Just a guess
5.1 How was time in sight determined? _ TIMED
5.2 Was object in sight continuously? NoK FADED
SIGHT.
.What was the condition of the sky? md conainfon or md sxy:
DAY DAY NIGHI NIGHT
a. a. Bright 9.
b. Cloudy b.
7.IF you sow the objoct during DAYLIGHT, whare was the SUN located as you locked a: the obiest?
(Circle One): a. (Circle One): a. In front of you In front of you d. To your laft To your left
b. In bock of you b. In bock of you . Overheod
c. To your right 1. Don't remember
FORM
FTD OCT 62 164 Thla form suporsedes FTD 164, Jul 61, whlch is obsolete. sind 164
11

Puga 3
14.Did tha objoct disappear while you ware zatching it? I1 so, how?
Yes. It faded out as it passed overhead.
(Circle One): Yes No Don't Know. IF you snswered YE, then tell what
it moved behind:
16. Did the object move in front of something at any time, particularly a cloud?
(Circle One): 1Ci7ci8On87. Yes No Don't Know. TNnow IF you answered YES, the. n! wiat IF you answered Yes, the. *
in front of: -. in front of: ._
17.  Toll in a fow words the following things about the object: 17. Toll in a few words the following things about the object:
a. Sound_none a. Soundnone
b. Color b. Color ___ as a bright light-like a star.
Wo wish to know the angular size. Hold a match stick at arm's langth in line with a known objost and i::
much of the object is covered by the head of the match. If you had performed this oxperiment at the tir: i
sighting, how much of the object would have been covered by the match head?
Probably all of it.
. Draw a picture that will show the shape of the object or objects. Label and include in your skatch any detoils
of ths 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.

22. Where were you located when you 2. Were yo irclo One)
(Circle One):
a. i the business section of a city?
0 Inside a building . In the residential suction oi a city?
b. In a car c. In open countryside?
c.j Outdoors d. Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea f. Flying ovar open country?
① Other I was indoors at first and_ g.
went outside to watch it..
wing questiona:
In order that you can give as clear a picture as possible of what you saw, dascribe in your own words
objoct or objects which, when placed up in the sky, would give the same appearance as the bject which you sow
When I first saw the light I thought it was a plane landing. This was because
it was much brighter than any stars. After watching i
wife and I both realized that it was not getting closer wife and I both realized that it was s not getting closer to the groung but higher to the groung but higher
in the sky. By the time it faded out it was almost directly overhead at what in the sky. By the time it faded out it v was almost directly overhead at what
appeared to be a good distance away.
.

show how high the object was above the horizon (skyline) when you last suw it. Place an ''.' on the compas:
B
NW HE
SW 3W
Draw a picture that will show the motion that the object or objects made. Place an "A'at the beginning of the 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.
3
29. IF there was MORE THAN ONE ob|oct, then how many ware there?.
Draw a plcture of how they wore arranged, and put an arrow to show tha direction that thay were traveling.

'1g0 &
30. Have you avar saen this, or a similar object befere. If so give dato or dates and location.
Several years ago, maybe four or five, I called in regarding flickering light
in the sky. This was in the NW. As I r remember and flickered
and was visible for quite some time.
.
Yos No
31.1 IF you answered YEs, did they see the object too? (Circle One) Yes No
31.2 Please list their names and addrosses:
Mrs.
Plaase give the following infermation about yourself:
NAME NAME
First Name Middlo Neme
ADDRESS Dayton 16 OhiQ_...-
Street City Zone Stato
TELEPHONE NUMBER AGE
exporience, whlch might be pertinent.
11 66
Day Month Year

Pago 7
questionnairo: 28 11 66
Day Month Your
. Information which you feel pertinent and which is not adequately covered in specific points of the
questionnaire or a narrative explanation of your sighting.
1
.
1

PROJECT 10073 RECORD
1. SATE M GROUP 1. SAT2 .IM GRSUP 2. LOCATION ! 2. LOCATION
14 November 66 15/03402 Dayton, Chio Dayton, Ohio (4 Witnesses)
3. SOURCE SOURCE 0. CONCLUSION CONCLUSION
Civilian Possible (AIRCRAFT) Possible (AIRCRAFT)
4 4. NUMBER OF OBJECTS
One
5. LENGTH OF OBSERVATION LENGTH OF OBSERYATION 1. ARIEF AUMMARY AND ANALYBIS 11, ARIEF AUMMARY AND ANALYBIS
2 Minutes Observers watched a star like object but seemed elongated in
6. TYPE OF OBSERVATION the direction of travel during the time it was the brightest.
The light did not seem to be moving at a constant velocity,
Ground-Visual
7. COURSE direction very slightly. The nearest comparison to this
behavior is the apparert motion of the Echo balloon satellite.
Northward which one of the witnesses has seen several times, after its
8. PHOTOS launch date, its velocity did not ajpear to be constant either.
Yes
XXNo vation.
2. PHYSICA EVIDENCE
Yes
XXNo
FORM
FTD SEP 63 0-329 (TDE) Prevloue ditione of thle form cay be ue.
.
.
4
2

This quostionnaire has been prepared so that you can give the U.S. Air Force as much
information as possib oncarning the unidentified aerial phenoinenon that you hovo olservai.
Please try to answar as many questions as you possibly can. TI he information that ycu givs wil!
be used for research pu urposes. Your name will not be used in connection with any statenienis,
conclusions, or publications without your permission. We request this personal Information sc
that if it is deemod ne we may contact you for further details.
1. When did yau see the objoct? Time of da! 43
Hovr Minutna
Nov. 1966
(Circle One): (Circle One): A.M. A.M. or (P.MJ P.M.
Day Day Month Yeur eur
. Time Zone: . Time Zone:
(Circle One):(0. (Circle One):(a. Eastern (Circla Une) a. (Circla Une): a. Doylight Soving
b. b. Contral b. Standard Standard T
c. Mountain
d. Pacific Pacific
. Other
4. Whore were you when you saw the object?
DAY+SN OHiS
Nearest Postal Address City or Town Stote or County
otal Duration
Hours Minutes Soconds
a. Certain c. Not very sure
. Fairly certain Td. Just a guess
5.1 How was time in sight determined?
5.2 Was object in sight continuously? Yos No---
What was the condition of the sky? O. Whdr was me condirilon or tha sxy?
DAY NIGHT
a. Bright a. o.
b. Cloudy b. Cloudy
(Circle One): a. In front of you (Circlo Ona): a. In front of you d. To your left To your left
b. In bock of you . . Ovorhead Ovorhead
c. To your right . Don't remember 1. Don't remember
FTD FORM
OCT 621 164 Thie form supereodos FTD 164, jul 61, which is obsolete.
.

Pags 2
8.1 STARS (Circle One): 8.2 MOON (Circle One):
a. None Bright moonlight
b. A fow b. Dull moonlight
c. Many c. No moonlight - pitch dark
d. Don't remember
9. What nere the weather conditions at the time you say object?
CLOUDS( Circle One): WEATHER(Circle One):
-a. Clear sky 0. Dry
b. Hazy 6. Fog, mist, or light rain
c. Scatternd clouds c. Moderate or heavy rain
d. Thick on houvy clouds Snow
e. Don't remember
10. The.object appeared: (Circle One).
a. Solid T d. As alight)
b. Transporent . Don't remember
c. Vapor
1. If it appeored as a light, was it b ighter than the brightest stars? (Circle Ons):
a. Brighter c. About the same
b. Dimmer d. Don't know
11.1 Compare brightness to some common object:
BRiGHT COLD POLDREO LIGHT
The edges of the object were:
(C..clo (ine) Fo. Fuzzy or blurred . Other
b. Like a bright stor
c. Sharply outlined
d. Don't remember
.Did the object: 13. Dia me oopser: (Circle One for eoch question) (Circre Ona ror •dch questfon)
a. Appear to stand still at any time? Appear to stand still at any time? Yes (No) Don't know
b. Suddanly spoed up and rush away at any time? Suddanly speed up and rush away at any time? Yes Don't know
c. Break up into parts or explods? Yes Don't know Don't know
d. Give off smoke? Give off smoke? Yes Don't know Don't know
. e. Change brightness? Yes Yos 99999299 9999299 Don't know
f. Change shape? Yes Yes Don't know Don't know
8. 9. Flash or flicker? Yes Don't know
h. Disappear and reappear? Disappear and reappear? Yes Don't know Don'tknow

Pugn 3
.Did the object move behind something at any time, particulurly a cloud?
(Circle Ona): Yes No Don't Know. IF you answered YEs, then tell what
it moved behind:
.Did the objeet mova in front of spmething at any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, the. n! wist
in front of: . in front of:
".
17. Toll in a few words the following things about the object: 17. Toll in a fow words the following things about the object:
o. SoundNoSeund o.SoundNoSeund
b. Color (cld b. Color (old
. We wish to know the angular size. Hold a match stick at arm's langth in line with a known ubjost and nr "…
much of the object is covered by the head of the match. If you had performed this experiment at the tirw: i si.
sighting, how much of the objoct would have been covered by the match head?
All of it
. 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 sspecially exhaust trails ar vapor trails.
Placs an arrow beside the drawing to show the direction the object was moving.
glowing .
E
light rays

(Circle One):
a. in: the business section of a city?
Inside a building b. In tha residential suction si a city?
b. In a car c. 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 oper country?
1. Other. g.
24. IF you were VING IN AN AUTOMOBILE or other vehicl estions:
The but
at on on altitude much too fow f 0
Cx C an A

Pago 2
8.IF you suw tho object at NIGHiT, what did you nolice concarning ths STARS and MOON?
8.1 STARS (Circle One): 8.2 MOON (Circle One):
a. None a. Bright moonlight
b. A fow b. Dull moonlight
Many No moonlight - pitch dark
d. Don't remember d.Don't remember
joct?
CLOUDS (Circle One): WEATHER (Circla One):
Clear sky Ory
b. Hazy Fog, mist, or light rain
c. Scattered clouds c. Moderate or heavy rain
d. Thick on houvy clouds Snow
6. Don't remember
0. The object appeared 10. The object appearad: (Circle One). Circle One). APTEARED COLD THROUN
.Solid As a light As a light A 144 RUER A 144 RNED TELGSCOrE
Transpaient . Don't remember
c. Vapor
. If it appaared as a light, was it brighter than the brightest stars? (Circle One):
Brighter c. About the same
b. Dimmer d. Don't know
11.1 Compare brightness to some common object:
SUeL1bH 1EROR
. The edges of the object were:
(C.clo(na) Fuzzy or blurred .Other sk
6 Like a bright star
O. Sharply outlined
d. Don't remember -
.Did the object: Did the object: (Circle One for each question) (Circle One for each question)
a. Appear to stand still at any time? Appear to stand still at any time? Y YI No Don't know
b. Suddanly speed up and rush away at any time? Yes Yes Not Don't know
c. Break up into parts or explode? Yes Yes No Don't know
d. Give off smoke? Yes N6 Don't know
. Change brightness? Yod Yow No Don't know
f. Change shape? Yes Yes No Don't know
g. Flash or flicker? Elash ox flickar? Yoi Yep No No Don't know Don't kmow
h. Disappear and reappear? YoD No Don't know
*
Hy
PAF

90° Seen W05 30 abore
75° - hori
The
NW
B A
A 118
sU SU
. Draw a picture that will show the motion that the object or objocts made. Place an "Aar the beginning of the 28. Draw a picture that will show the motion that the object or objocts made. Place an "A' ar the beginning of the
path, a "B" at the end of the path, and show any changes in direction during the course.
B
29. IF there was MORE THAN ONE oblact, then how many were there?
.
.

Was anyone else with you at the time you saw the objact? (Circle One) Yo No
ircl Ona) (Yos) No
addresses:
pO.UE
TS1DE AND
Ew LEBANOn OHiC EuLEBANO
21
NA (ame First Namo irst Nama Middlo Neme Middlo Neme
Name
ADD $\rac{$ OHiO
City Stato
TELEPHONE NUMBI AGE 45 SEX F
uding any spocial exparience, which might bo pertinont. T
3.When and to whom did you reper When and to whom did you ro I that you had oon the objoct?M that you had soon the objoct? Mth onduty ondut
1.5 Nov. Nov 1966 1966 at Uto phone UFo phone
Day Month Month Yoar Year AT AT WPAFB

Pogo 7
3Date you complatad this quastionnaire: 1966
Day Month Yoar
Informatien which you fael pertinent and which is not adoquately covered in the
questionnaire or a narrative explanation of your sighting.

Daytoi Oln
FTD (TDETR)
Wright-Patterson AFB, Ohio 45433
16 November 1966
Dear
Reference your recent unidentified observation of  November
1966. The information which you provided to the Duty Officer
was not sufficient or evaluation. Request you couplete the
attached FTD Form l64 and return it in the envelope provided.
We wish to thank you for reporting your observation to the
Air Force.
1

Deyto Ohe
FTD TDETR)
Wright-Patterson AFB, Ohio 45433
16 November 1966
Dayton, Chio
Dear
Reference your recent unidentified observation of  November
1966. The information which you provided to the Duty Officer
was not sufficient for evaluation. Request you complete the
We wish to t thank you for reporting your observation to the
Air Force.

..
0066
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 purposes. Your 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, may contact you for further details.
When did you see the object? Time of day: 1P 45
Hour Minutes
i4 19 /1
(Circle One): (Circle One): A.M. or P.M. P.M.
Doy Day Month Year
3. Time Zone: 3. Time Zone:
(Circle One); a. Eastern (Circle One): Daylight Saving
Central Central b. Standard
c. Mountain
d. Pacific
e. e. Other Other 11
4. Where were you when you saw the object?
Ohis
Nearest Postal Address City or Town State or County
.How long was object in sight? (Total Duration) 3
Hours Minutes Seconds
aCertain .Not very sure
b. Fairly certain
5.1 How was time in sight determined? _
5.2 Was object in sight continuously? Yos X No
6. What was the condition of the sky? O. What was the condition of the sky?
DAY DAY NIGHT...
a. a. Bright a. Bright a. Bright
b. 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. | (Circle One): a. In front of you d. To your left
b. In back of you b. In back of you e. Overheod
c. To your right c. To your right f. Don't remember f. Don't remember
FTD FORM
OCT 621 164 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): 7
a. None a. Bright moonlight
b. A few- b. 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. a. Clear sky Clear sky a. Dry
b. Hazy b. tazy b. Fog, mist, or light rain
c. Scattered clouds Scattered clouds c. Moderate or heavy rain
Thick or heavy clouds Thick or heavy clouds d. d. Snow
e. e. Don't remember Don't remember
The object appeared: (Circle One): 10. The object appeared: (Circle One):
BughT RughT
a. Solid a. Solid d. As a light
. Transparent e. Don't remember
c. Vapor
If it appeared as a light, was it brighter than the brightest stars Circle One):
a. Brighter c. About the same
b. Dimmer d. Don't know
11.1 Compare brightness to some common object: ,
Breit a bight slis
1.The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright star
c.Sharply outtined
J. Don't remember Tremember
Did the object: . Did the object: (Circle One for each question) (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? S No Don't know
c. c. Break up into parts or explode? (No, (No Don't know
d. Give off smoke? Yes No Don't know Don't know
e. e. Change brightness? Yes No. Don't know
f. Change shape? Change shape? Yes Ng No Don't know
g. Flash or flicker? Yes No Don't know
h. Disappear and reappear? Yes No Don't know
.

Page 3
Yu -faded ant
1.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:
1. Did the object move in front of something at any time, particularly a cloud?
(Circle One): Yes No 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. Sound _ a. Sound
b. Color WI+ITG LOItITG -yellon -uoiha.
. 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?
(
Sfme quge
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.
lhe Stan lhe Shan
Shuney Shney
V

Page 4
20. Do you think you can estimate the speed of the object?
(Circle One) Yes No
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? .
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 Inside a building b. In the residential section of a city? b. In the residential section of a city?
b. In a car In a car c. In open countryside? c. In open countryside?
c. c. Outdoors d. Near an airfield? Near an airfield?
d. d. In an airplane (type) e. Flying over a city?
e. At sea f. Flying over open country? Flying over open country?
f. Other Other g. Other. Other .
IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: .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
b. Northeast d. Southeast f. Southwest 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
Did you observe the object through any of the following?
a. Eyeglasses Yes No e. Binoculars Yes
b. Sun glasses Yes No f. Telescope
c. Windshield Yes No g. Theodolite Yes
d. Window glass es 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
She

Pag• 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) whon you first saw it. Place a "B" on the same curvad line to
show how high the object was above the horizon (skyline) whon you last saw it. Place an "A" on the compass
75
/
NW NE
f
30°
15° SW
s5 S5
A S
Draw a picture that will show the motion that the object or objects made. Place an "A"at the beginning of the 29 ioet or ohiocts ma o5L
path, a "B" at the end of the path, and sliun any changes in direction during the course.
mightoauhedl
Canne
2. IF there was MORE THAN ONE object, then how many were there? . one
Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.
.

(Circle One) Yes
IF you answered YEs, then how far away would you say it was? _
w the object? Circle One)
(Circle One):
in the business section of a city?
inside a building In tha residential suction si a city?
b. In a car c. In open countryside?
Ce Outdoors Near an airfield?
d. In an airplane (type) . Flying over a city?
e. At sea
1. Other
lowing questions:
24.1 What direction were you moving? ircle Ona)
a. North c. East South y. West
b. Northeast d. Southeast f. Southwest h. Northwost
24.2 How fast were you moving? — miles per hour.
24.3 Did you stop at any time while you ware looking at the object?
(Circla One) Yes No
2.Did you observe the objoct through any of the following?
a. Eyoglasses Yos No .Binoculars Yes
b. Sun glasses Yes . Telescope Yes No
c. Windshiold Yes No g.i Theodolite Yes No
d. Window glass Yes No h. Other -
1

Page 6
30. Have you ever seen this, or a similar object before. If so give date or dates and location.
, oe ar pouly Ayiagote
No
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:
32. Please give the following information about yourself: . Please give the following information about yourself:
NAME
Last Name Middle Name
ADDRESS DAYTON O1+10
Street Zone State
TELEPHONE NUMBER AGE 42 SEX M
Indicate any additional information about yourself, including any special experience, which might be pertinent.
a
8
33. When and to whom did you report that you had seen the object?
1L 11 6t
Day Month ear

Diy tow
she was tatkng to daght o shn a tine
Dairgh Lto in
Her con Saw 3g 3^g
.

.
PROJECT :0073 RECORD
1. DATE · TIME GROUP 2 LOCATION
14 Nov. 66 15/03452 Dayton, Chio three witnesses
3. SOURCE 3. SOURCE 10. CONCLUSION TO. CONCLUSION
Civilian Civilian Aircraft(possible) Aircraft(possible)
4. NUMBER OF OBJECTS 4. NUMBER OF OBJECTS
one one
5. LENGTH OF OBSERVATION 11. 11. BRIEF SUMMARY AND ANALYSIS BRIEF SUMMARY AND ANALYSIS
4 minutes 4 minutes Observers watched a gold colored object travel toward the Observers watched a old colored object travel toward the
. TYPE OF OBSERVATION TYPE OF OBSERVATION western sky. The ob; ect was visible forbout 4 minutes
before fading frcm. Cbject was compared to the
Ground Visual brightest star, but :. altitude much to low for a star,
7. COURSE and the object wss moring. When last seen the object
was about 30 degrees bove the horicon.
westward
8. PHOTOS The description is consistent with that an aircraft
observation.
Yes
No
9. PHYSICAL EVIDENCE
Yos
No
FORM
FTD SEP 63 0-329 (TDE) Previous editions of this form may br ised.
: :
.
7

U.S. AIR FORCE TECHNICAL INFORMATION -
This questionnair has been prepared that you can give the U.S. Air Force as much
information as poss concerning the unidentified aerial phenomenon that you have observed.
Please try to answer nany 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, we may contact for further details.
.When did you see the object? 2. Time of day: 10 40±5
Hour Minutes
14 14 NOVeMBER NOVEMBER 1966 1966 (Circle One): (Circle One): A.M. P.M.
or P.M.
Day Month Month Year
3. Time Zone:
(Circle One):a. (Circle One):a. Eastern (Circle One): a. Daylight Saving
b. Central b. Standard
c. Mountain
d. Pacific
e. Other Other
4. Where were you when you saw the object?
DAYTON OH10
Nearest Postal Address City or Town Stata or County
5. How long was object in sight? . (Total Duration) 2±\fra}$
Hours Minutes Seconds
. Certain c. Not very sure
b. Fairly certain d. Just a guess
5.1 How was time in sight determined? ESTIMATION OF TIME SPENT WATCHING
5.2 Was object in sight continuously? Yes I NoV
What was the condition of the sky? 6. What was the condition of the sky?
DAY NIGHT
a. Bright 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. (Circle One): aIn front of you In front of you d. d. To your left
b. In back of you b. In back of you e. e. Overhead
c. To your right f. Don't remember
FTD FORM
OCT 62 164 This form supersedes FTD 164, Jul 61, which is obsolete.

.
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. 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 C a. Dry
b. Hazy b. Fog, mist, or light rain
C. Scattered clouds -NOTSURE Scattered clouds -NOTSURE c. c. Moderate or heavy rain Moderate or heavy rain
d. Thick or heavy clouds Thick or heavy clouds d. Snow Snow
e. e. Don't remember Don't remember
10. The object appeared: (Circle One): . The object appeared: (Circle One):
a. Solid d. As a light d. As a light
b. Transparent Transparent e. Don't remember e. Don't remember
c. Vapor
1. If it appeared as a light, was it brighter than the brightest stars? (Circle One):
a. Brighter PART OF c. About the same
b. Dimmer THE TIME d. Don't know
11.1 Compare brightness to some common object:
FIRST APPEARED A BOUT AS BRIGHT AS STARS IN CONSTELLATION ORION
IIEN GREW BRIGHTER AS IT PASSED OUGRHEAO
12.The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other VERY MUCH LIKE A STAR,
b. Like a bright star BUT SEEMED SOME WHAT
c. Sharply outlined ELONGATED IN THE DIRECTION
d. Don't remember OF TRAUEL DURING IHE
TIME IT WAS RRIGHTEST
Did the object: (Circle One for each question) .
Sid me obleer: (Circre One Tor edcn quesrion)
a. Appear to stand still at any time? Appear to stand still at any time? Yes No No Don't know Don't know
b. Suddenly speed up and rush away at any time? Yes NO Don't know Don't know
c. Break up into parts or explode? Yes Yes №\o No Don't know Don't know
d. Give off smoke? Yes No No Don't know
e. e. Change brightness? Yes No Don't know
f. Change shape? possibly Yes No Don't know
g. Flash or flicker? Yes No Don't know Don'tknow
h. Disappear and reappear? Yes No Don't know Don't know

DEMINISH IN BRIGHTNESS AS IT MOUED ON DAST THE OVERHEAD POSITION,
.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: IF IT DID, IT WASN'T OBVIOUS. PERHARS GLOUDS ACCOWNT
FOR ITS DISAPDEARANCE - THERE DIDNT SEEM TO BE ASMANY STARS
VISIBLG IN THE WESTE
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. Sound _ NONE
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.
THE DISCRIPTION AS A STAR THE DISCRIPTION AS A STAR -AS A POINT - AS A POINT OF LGHT
E THAN
A PICTURE. How Do you Howi D0 you DRAW PICTURE

21. Do you think you can estimate how far away from you the object was? ONLY VERY ROUGHLY-
ITSEF VELOCITY DID NOT APPEAR CONSTANT-
(Circle One) Yes NOIT SEEMED TO CHANGE VELOLITY,OR JOMP
ALONG WHICH I WOULD INTERPRET AS
IF you answered YES, then how far away would you say it was? ABBERATION MaSPHERIC
DUE TO
AS
Where were you located when you saw the object? Were you (Circle One)
(Circle One):
a.In the business section of a city?
Inside a building a. b.In the residential section of a city? .In the residential section of a city?
b. In a car In a car c. . In open countryside? In open countryside?
c. c. Outdoors d. Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. . At sea At sea f. Flying over open country? Flying over open country?
f. f. Other g. Other A CHURCH PARKING LOT NEAR A CHURLH PARKING LOT NEAR
A RESIDENTIAL SECTION
IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the following questions: 24. IF you were MOVING IN AN AUTOMOBILE or other vehicle at the time, then complete the follow ing 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
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 e. Binoculars Yes
b. Sun glasses f. Telescope Yes 8
c. Windshield Yes No g. Theodolite 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 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 appearance as the object which you saw.
A STAR A STAR

Pago 5
2. In the following sketch, imagine that you are at the point shown. Place an "A"" on the curved line to show how
when you first saw it. Place a "B"' on the compass where you last saw the object.
90° 75° B
609
NW NU
O E →
A
-15° 15° SW
path, a "B" at the end of the path, changes in direction during the course.
B4 ROUGHLY A
I TRAUELED
1 STRAIGHT LINE
1
BUILDiN 1 EASTERN
WESTERN I HORIZON
IONZON
2. IF there was MORE THAN ONE object, then how many were there? ONLY ONE
Draw a picture of ho 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.
No
3. Was anyone else 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? ircle One) Yes No
31.2 Please list their names and addresses:
,DAyrON
ON
DAYTON
.Please give the following information about yourself:
NAME
Lasf "Name First Name
any speci
I AMA WITH AN M.S. IN ORGANIC
CHEMISTRY. I AM INTERESTED IN 1ALL BRANCHES OF SCIENCE
AND TRY TO REEP
When and to whom did you report that you had seen the object?
16 NOVEMBER 1966
Day Day Month Month Year
BLUE BOOK A ATWRIGHT PATTFRSON PATTERSON
CALLED PROJECT

STANOING
AND BY BRIGHTER BND HAD
MOVED eizau) io t01201 THE THOE
V2L5S774 9n N67 RCSOME TAS 7
DJE TO 7
DEFRACT THE LIGHT DIFFERENTLY AS THE OBJECT MOUES. FI WOULD FEI WOULD
JUDGE THAT THE OBJECT WOULD HAUE TO BE QUITE MISH FOR THIS EFFECT JUDGE THAT THE OBJECT WOULD HAUE TO BE QUITE MIGH FOR THIS EFFECT
TO BE DBSERUABLE. TO BF DBSERUABLE. THROUGHTHE ARC
OBSERUED AT SUCHANA ITUDE, IN THE TIME . TIME OBSERUED, ITS VELCCITY OBSERUED, ITS VELCCITY
MUST HAUE BEEN QUITE NIGN.

Puge 3
If so, how?
T
time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answored YEd, then teli what
it moved behind: .
1.Did the objeet move in front of spmething at any time, particularly a cloud?
(Circle One): Yos NG Don't Know. IF you answered YES, the. *! wist
in front of:_.
. Sound_
b. Color_ whetink
not vee :
The thie amatchherl.
.Draw a plcture that will show the shape of the object or objects. Label and include in your sketch any dotails
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.
√
...

PRUJE-I 1O0TSAECON
1. DATE · TIME GROUP 2. LOCATION
18 Nov. 66 19/04002 sayoon, sayoon, Chio Chio one witness one witness
3. SOURCE 3. SODECE 10. CONCLUSION . CONCLUSION
Civilian Aircraft a (po0) " (pesi)
4. NUMBER OF OBJECTS
Cluster of lights Cluster of lights
. LENGTH OF OBSERVATION . LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS 11. BRIEF SUMMARY AND ANALYSIS
Observer noted a cluster of white lights that traveled
6. TYPE OF OBSERVATION toward the cast. As it tr reled away the white light
Ground Visual cluster faded then began steady glow
light. The object
7. COURSE was to far away to defi shape other than as a
Eastward cluster of lights.
8. PHOTOS Contact was made with WP AFB operations but they nad no
Yos traffic departing the base at O OZ 19 Nov. 66
X No
9. PHYSICAI VIDENCE Description consistent with that
observations
Yes
XNo
FORM
FTD SEP 63 0-329 (TDE) Previoue editions of this form may be ueed.
-
.
:'
.

U.S. AIR INFORMATION
This questionnaire has been prepared so that you can give the U.S. Air Force as much
information as possib concerning the unidentified aerial phenomenon that you have ol servai.
Please try to answer any questions as you possibly can. The information that ycu giva will
ba used for research poses. Your name will not be usod in connaction with any statenenis,
conclusions, or publications without your permission. We request this personal Information sc
that if it is deemed necessary, we may contact you fo her details.
? NG
.When did you see the object? ?. Time of CC 04c0t
Hour Minuina
18 Nov1916 iCircle One): A.M. or P.M.
Day Month Your
3. Time Zone:
(Circle One):a) Eastern (Circle Une): a. Daylight Soving
Central b. Standard
c. Mountain
d. Pacific
e. Other
City or Town Stata or County
5. How long was object in si (Total Duration) C -3
Hours Minutes Seconds
a. Cortain c. Not very sure
Fairly certain d. Just a guess
5.1 How was time in sight determined?Estiniétd
5.2 Was objoct in sight continuously? Yes No-—-
6. What was the condition of the sky?
DAY NIGHT
a. a. Co. do. Bright
b. Cloudy
(Circls Ona): a. In front of you (Circls Ona): a. In front of you d. To your left
b. In bock of you b. In bock of you . Overheod
c. To your right f. f. Don't romember Don't remember
FTD FORM
OCT 62 164 This form superes 164, Jul 61, which obaolete.

8.1 STARS (C.ircle One): 8.2 MOON(Circle One):
a. None Bright moonlight
b. A few b. Dull moonlight-flhe. cie. hend.
c. Many No moonlight - pitch dark
Don't remember d.
the weather con m& at time you sav pjoct?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky 0 Dry
b. Hasy b. Fog, mist, or light rain
C Scotternd clouds c. Moderate or heavy rain
d. Snow
•. Don't remember
10. The object appeared: rcle One).
o. Solid A. As a light -Clust roflightswihen
b. Transpoiont 6, Don't remember rcpulsat.
c. Vapor 4
OB Brighter c. About the same
b. Dimmer d. Don't know
oblece: Large light bulbs.
The edges of the object were:
(Circlo(na) a. Fuzzy or blurred . Other Tse for neeay to defin
b. Like a bright stor
c, Sharply outlined
d. Don't remember ofLghts
Did the object: Did the object: (Circle One for each question) (Circlo One for each question)
a. Appear to stand still at any time?li hea  clusf Y Appear to stand still at any time?ll hearclusf Ys No No Don't know
b. Suddenly speed up and rush away at any time? Suddanly speed up and rush away at any time? Yes No No Don't know
c. Break up into parts or explode? Yes (No Don't know
d. Give off smoke? Yos No Don't know
o. Change brightness? Yes No No Don't know
f. Change shape? Yes Yes No Don't know
g. Flash orflickor? cihite e/sirc. Flash orflickor? cihite e/sirc Yes No Don't know
h. Disappear and reappear? GeineYes No Don't know
pudfanl

(Circle One): Yes No Don't Know. IF you answered YEs, then tal what
it moved behind:
.Did the objoet mova in front of something at any time, particularly a cloud?
(Circle One): Yes Don't Know. IF you answered YES. the th! wist
in front of: _.
17. Tell in a fow words the following things about the object:
b. ColorLeeite m14

(Circle One) Yes No
IF you answered
22. Whore were you located 23. Were you (Circle One)
(Circle One):
a. in the business section of a city?
Inside a building C5. In the residential suction oi a city?
b. In a car c. In open countryside?
c. Outdoors d. Near an airfield?
d. In an airplane (rype) e. Flying over a city?
e. At sea f.
1. Other ___ g.
ving quostions:
a. North c. East South y. West
. Northeast d. Southeast f. Southwest 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) Yos No
Did you observe the object through any of the following?
a. Eyoglassos Yes \st}$ e. Binoculars Yes No
b. Sun glasses No f. Telescope Yes No
c. Windshiold No g. Theodolite Yes No
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 wor a common
object or objocts which, when placed up in ths sky, would give the same appearance as the objsct whls you sow
L

when you flrst saw it. Place a "B"" on the compass where re you last saw the chjoct.
90°
31.
NE
13• M
H→ 3
3: 3:
path, a "B" at the end of the path, and show any changes in direction during the course.
→A E
Li
S
29. IF thore was MORE THAN ONE objoct, then how many were
Draw a picture of how they ware arranged, and put an arre row to show the direction that thoy ware traveling.
Def His te/uisler.
.

no6
30. Havs you aver seen this, or a similar object bafore. If so give date or dares and location.
Ne
31. Was anyone else with you at the time you saw the objact? (Circle Ons) Yos No
Yes No
31.2 Ploase list their names end addresses:
+
32. Please give the following Infermation about yourself: -
NAME NAME
Last Name FIrst Name Irst Name Middlo Neme
ADDRESS s burgbeDiea ia bie
Streel Ciy Stato
TELEPHONE AGE /2 SEX Dn/e
Indicate any additional Inform matlon about yourself, including any experiance, which might be pertinont.
When and to whom did you report that you had sean the object? When and to whom did you repart that you had sean the object?
15
Day Day Month Yoar
Dete

Page 7
34. Dats you compl 18
Day Month Yoor
Information which you faul pertinent and which is not adequately covered in specific points of the
questionnaire or a narrative explanation of your sighting.
1

∵.…
22 Nov. 66
Contact was made with WP AFB operations regarding the observence
of an alleged UFO the Dayton a on 18 Nov. 66 at approx-
imately 2300L were two aircraft which landed at the base
shortly before the time of the sighting. Therw was no traffic
leaving the base at the time of the sighting. Descriptin is
consistent with that of an aircraft which would be in a slowly
rising after take off pattern. It is possible that the observer
saw one of these two aircraft in a landing pattern. Both aircraft saw one of these two aircraft in a landing pattern. Both aircraft
were of the DC-6 class. were of the DC-6 class.
.
T
.

.
PROJECT 10O7S RECORD
1. CATE - TIME GROUP 2. LOCATION
1November 66 19/02152 15 .:0vemcer 66 19/02152 Dayton, Ohio Dayton, Ohio (2 Witnesses) 2..itnesses
. SOURCE 3. SOURCE 10. CONCLUSION 10. CONCLUSION
Civilian
4. 4. NUMBER OF OBJECTS
One
5. LENGTH OF OBSERVATION LENGTH OF OBSERVATION 11. BRISF SUMMARY AND ANALYSIS
30 Seconds Observer watched a luminesent object travel steadly beyord
6. TYPE OF OBSERVATION observers k sight. Object went just under the cloud layer.
Observer noted that the sound heard was similar to that
Ground-Visual
7. COURSE to a lower winged aircraft.
Description is consistnet with that of an aircraft sighting.
Westward
8. PHOTOS
Yes
XXNo
9. PHYSICA IDENCE
n7 Yes
XXNo
FORM
FTD SEP 63 0-329 (TDE) Previous editlans of thle form may bo usod.
-
0
.

90° 75
NW
3
IS•A S•A M
2. Draw a plcture that will show the motion that the object or objects mado. Place an "A'at the beginning of she
path, a " at the end of the path, and show any changes in direction during the course.
2. IF thare was MORE THAN ONE oblact, then how many were there?
Draw a pleture of he y wore arranged, and put an arrow to show the direction that thoy were traveling.

'
U.S. AIR FORCE TECHNICAL. INFORMATION
This questionnaire has been prepared so that you can give the U.S. Air Force as much
1 information as possible concerning the unidentified aerial phenoinenon that you havou ol servei.
Ploase try to answer as mas y questions as you possibly can. The information that ycu give will
ba used for research purposes. Your name will not be used in connection with any statomenis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed necessary, we may contact you for further details.
1. When did you see the object? 2. fime of da,. 9:15 15
Hour Minutns /
'S Nex1914 (Circle One): A.M. or P.M.
Day Month Yeur
. Time Zone:
(Circle One): (o. (a. Eastern (Circle Une): . (Circle Une): a. Daylight So.ing Daylight So.ing
b. b. Central b. 6. Standard Standard
c. Mountain
d. Pacific
. Other
4. Whore were you when you saw the objoct?
- Dafe Chio
Neorest Postal Address City or Town State or Coumty
Total Duration) C 32
Hours Minutes Seconds
a. Certain c. Not very sura
Fairly certain d. Just a guess
5.2 Was object in sight continuously? YosK No -—
6. What was the condition of the sky?
DAY NIGHT NIGHT
a. Bright
b. Cloudy b. Cloudy b. Cloudy
7. IF you saw the objoct during DAYLIGHT, whore was the SUN located as you locked a: the obiest? 7. IF you sow the objoct during DAYLIGHT, where was the SUN locatad as you locked a: the obiest?
(Circlo One):a.In front of you (Circla One):) In front of you d. To your left d. To your left
b. In bock of you o. Overhead
c. To your right f. Don't remember
FTD FORM
OCT 62 164 Thle form suparssdee PTD 154, jul 61, which is obsolste.
1

Pago 2
8.IF you sow the objoct ot NIGHT, what did you nolice concarning th• STARS and MOON?
8.1 STARS (C.Ircle 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. Don't remember d. Don't remember
object?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky Dry
b. Haxy b. Fog, mist, or light rain
c. Scalternd clouds c. Moderate ar heavy rain
a Thick  houry clouds d. Snow
e. Don't remomber
10. Tha object appeared: (Circls One). Tha object appeared: (Circls One).
o. Solid d. As o light
. Transpoient . Transpoiont .Don't remember . Don't remember
c. Vapur Lightly LightLy uminnted khike
11. If it appeared as a light, was hter than the brightest stars? Circle One):
a. Brighter c. About the same
b. Dimmer d. Don't know
11.1 Compar
Ei  dt
The edges of the objoct were:
(Ciclo (ina) a. Fuzzy or blurred . Other-
b. Like a bright stor
Sharply outlined
d. Don't romember
Did the object: 13. Did ma object: (Circle One for each quastion) (Circle One tor eæch quastion)
a. Appear to stand still at any time? still at any tima? Yes Don't know Don't know
b. b. Suddanly spoed up and rush away at any time? Suddanly speed up and rush away at any time? Yes Don't know
c. c. Break up into parts or explode? Yes Don't know
d. Give off smoke? Givs off smoke? Yes Yes @9909989 Don't know
. . Change brightness? Change brightnass? Yes 29989989 Don't know
f. Changa shape? Change shape? Yes Don'tknow
g. Flash or flicker? Yes Yes Don't know
h. Disappear and reappear? Yes Don't know
.

--
Toll in a few words the following things about the object:
b. ColorL
Draw a plcture that will show the shape of the objoct or objects. Label and include i in your sketch any details
of ths object that you saw such as wings, protrusions, etc., and especially exhaust trails ar vapor trails.
Jihe a daue
ciat hane a uotuding Tat lan a La-Z mae
-
:

Circlo One)
(Circle One):
a. in the business soction of a city?
a. Inside a building b. In. she residential secticn oi a city?
b. In a car In open countryside?
E. Outdoors d. Near an airfield?
d. In an airplane (type) e. Flying ovar a city?
e. At sea f. Flying over open country?
1. g.
24. IF you were VING IN AN AUTOMOBILE or other vahicle at the time, then completo the
a. North c. East . South y. West
b. Northeast d. Southeast f. Southwest 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
2Did you observe the object through any of ths following?
a. Eyoglasses Yes o. Binoculars
b. Sun glasses Yes f. Telescope C0
c. Windshield Yes g. Theodolite Yes
d. Window glass Yes h. Other _
s ln

DErhend
75 (HAESt)
60
Na
4
13
15' 3W
M
Act1B t /3
Draw a picture that will show the motion that the object or objects mado. Place an Aar the beginning of the
path, a "" at the end of the path, and show any changes in direction during the course.
1
E
B <
S
2. IF thore was MORE THAN ONE objoct, than how many wers thore? — Cneenf
Draw a plcture of how they were arranged, and put an arrow to show the direction that thoy wore traveling.

objoct? (Circle One) Yos No
3.1 IF you answerad YES, did they see the object too? (Circle One) Y0 No
31.2 Pleese list their nam nd addrosses:
MR (Li:fe)
a
32. Pleass give the fallowing Infemation about yourself: . Pleass give the following Infemation about yourself:
NAME
Last Neme First Name Milddlo Neme
ADDRESS Chic
CIty Zone Stae
TELEPHONE NUMBER 4 SEX MAlE
Indieate any etion about yourself, including any spec experience, which might bo pertinenr.
-
3When and to whem did you ropart that you had seen the obiect? When and to whem did you ropart that you had seen the obiact?
15 Nei Ci 191L 1911
Day Month Your

,
Pago 7
34. Dat you com ed this questionnaire: /5/i 1.4
Doy Month Your
questionnaire or a narrative explanation of your sighting.

yes.
Twie befu the suviape Mel
No
31.1 IF you answored YEs, did they see the object too? (Circle One) No
31.2 Please list thair namos end addresses:
, 3 yes
adhese ihor
1 y
15yn )
NAME
est Nome First Name First Name Middlo Neme Middlo Name
Dayton 6 Ohi
City Zone Stato
TELEPHONE NUMBE AGE 36 SEX F
Indicate any additional Information about yourself, Including any spoclal experionce, which might bo pertinent.
9
When and to whom did you ropert that you had sean the object? .Whan and to whom did you rapor that you had seen the object?
CAPT HEINERs MeINerS FTD D.O. C.
Day Day Month Year EXT EXT 70178 70198

Page 7
Dote you comploted this quastlonnaire: C5 1E6G
Dey Month Your +
questionnaire or a narrative explanation of your sighting.