PROJECT BLUE BOOK

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PRUJE IUU/S RECURD
1. (ATE · TIME GROUP 2. LOCATION
15 Nov 66 15307 Doylestown, ieni.
3. SOURCE 0. CONCLUSION
Civilian Civilian INSUFFICIENT DFT: OR EVALUATION INSUFFICIENT I. T.. "OR EVALUATION
4. NUMBER OF OBJECTS OBJECTS
One
5. LENGTH OF OBSERVATION 11. 11. BRIEF SUMMARY AND ANALYSIS T
One hour SEE CASE
6. TYPE OF OBSERVATION
Air Visual Air Visual .
7. COURSE
SE
8. PHOTOS :
D Yes I
No
2. PHYSICAL ….
17 Yos
XNo
FORM
FTD SEP 63 0-329 (TDE) Previous editlons of this form may bo used.
2

Naral Hn.
11
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 phenoinenon that you havo observei.
Please try to answer questions as you possibly can. The information that ycu give will
be used for research purposes. Your name will not be used in connoction with any statemienis,
conclusions, or publications without your permission. We request this personal information sc
that if it is deemed nece we may contact you for further details.
1. When did you see the object? 30
Hour Minutes
66 (Circle One): (Circle One): A.M. A.M. or
or P.M.
Day Month Yeur Your
. Time Zone: . Time Zone:
(Circle One): a Eastern (Circle Une): a.Doylight Sa:ing (Circle One): a._Doylight Saving
b. Eontral b. Standard
c. Mountain
d. Pacific
. Other
4. Where were you when you saw the object?
Nearest Postal Address City or Town Srate or County
(Total Duration) ~1
Hours Minutes Seconds
Certain c. Not very sure
b. Fairly certain dJust a guess
5.1 How was time in sight determined? L/
5.2 Was objoct in sight continuously? YosK No--
.What was the condition of the sky?
DAY NIGHT NIGHI
a. a. Bright Bright
b. Cloudy b. Cloudy
7.IF you sow the objoct during DAYLIGHT, whare was the SUN located as you locked a: ths obiest? 7.IF you sow the objoct during DAYLIGHT, whare was the SUN located as you locked a: the obiest?
(Circle Ona): a. In front of you d. d. To your left To your left
b. In bock of you o. Overhead Overheod Send 164
c. To your right c. To your righ! f. Don't remomber Don't remomber
FORM
FTD OCT 62 164 Thie form aupereede 4. Jul 61, which obenlete.

Page 2
8IF you saw the object at NIGHiT, what did you notice concerning the STARS and MOON?
8.1 STARS (C.ircle One): 8.2 MOON (Circl One):
a. None a. Bright moonlight
b. A few b. Dull moonlight
c. Many c. No moonlight - pitch dark
d. Don't remember .Don't remember
9. What nere the weather conditions at the time you saw pjoct?
CLOUDS (Circl One): WEATHER (Circle One):
a. Clear sky- 0.Dry
b. Hazy b. Fog, mist, or light roin
c. Scatternd clouds c. Moderate or heavy rain
d. Thick x houvycloud Thick on houvy clouds Snow Snow
. 6. Don't remember Don't remomber
.The object appeared 0. The object appeared Circle One).
a. Solid a. Solid t. As a light
b. b. Transpoiont . Don't remember Don't remember
c. Vapur
1 If it appeared as a light, was it brighter than the brightest stars? (Circle One):
a. Brighter c. About the same flashing many bight
b. Dimmer d. Don't know
11.1 Compar lights
htness to some common objoct:
12. The edges oi the object were:
(C..i0(n0) a.F Fuzzy or blurred . Other
b. Like a bright stor
C. Sharply outlined
d. Don't remember
Did the object: 1.Did the object: (Circle One for sach question) (Circle One for sach question)
a. Appear to stand still at any time? Appear to stand ill at any time? Yes No Don't know
b. Suddenly speod up and rush away at any time? Suddenly speod up and rush away at any time? Yes No Don't know Don't know
c. Break up into parts or explode? Yes No Don't know
d. Give off smoke? Yes Yes No Don't know
. . Change brightness? Yes No Don't know
1. 1. Change shape? Chang shape? Yes (No Don't know
g. Flash or flickor? Flash or flickor? Yes No Don't know.
h. Disappear and reappear? Yes No Don't know
I

Pugn 3
14. Did the object disappear while you were vatching it? li so, how?
N
1.Did the objoct move behind something at any time, particulurly 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): (Circle One): Yes No No Don't Know. Don't Know. IF you answered YES, the.; n!l wist IF you answered ES. the all wit
in front of:
17. Tell in a few words the following things about the object:
. Sound.. a. Sound. No
. Color _ b. Color _
*…*
We wish to know the angular size. Hold a match stick at arm's length in line with a known ubjoct and
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 objsct would have been covered by the match head?
1. Draw a plcture that will show the shape of the objoct or objects. Label and include 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.
.

(Circle One) Yes No
23. Wore you (Circlo One)
(Circle One):
a. ir the business section of a city?
0.1 Insido a building b. In. tha residential suction oi a city?
b. In a car In open countryside?
c. Outdoors dNear an airfield?
d. In an airplane (type) e. Flying over a city?
. At sea f. Flying over open country?
g. Other
comole
(Circle One) Yos No
a. Eyoglasses No e. Binoculars Yes
b. Sun glasses Yes No f. Telescope Yes No
c. Windshisld g. Theodolite Yes No
d. Window glass Yes No h. Other-
a common
object or objects which, whon placed up in th ich you sow
,

900 Ojet
73
Sactkeastof AUPSMTIOA
NU
15 N 3W SC SC
Tr
Draw a picture that will show the motion that the object or objects made. Place an Aar the beginning of th
path, a "8" at the end of the path, and show any changes in direction during the course.
29. IF there was MORE THAN ONE object, then how many ware there? _
Draw a plcture of how they were arranged, and put an arrow to show the direction that thoy ware traveling. -
BE

'2go 6
30. Have you over soon this, or a similar objoct bo ofore. If so give date or datas and locarion.
Was anyone else with you at the time you saw the objoct? (Circle One) Yes No
31.1 IF you answerad YES, did they see the object too? (Circls One) Yos No
31.2 Ploase list thoir names and addresses:
32. Please give the following Infermation about yourself: 2. Please give the following Infermation about yourself:
2
NAM
Last Name First Name Firat Name Middlo Neme Middlo Heme
ADDRESS Deylestcu
City Zone Stato
2
TELE SEX M
.
When and to whom did you ropert that you had soen the object? .Whan and to whom did you repart that you had soen the object?
/5 15 Nr 66
Doy Day Month Year Year 01
Nanal li Hatn

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34. Dats you con questionnaire: An C6
Day Month Your
Information which you feal pertinent and which is not adequately covered in t specific pointa of the
qusstionnaire or a narrative explanation of your sighting.

TDET/UFO
15 December 1966
UFO Observation, 15 November 1966
Road
Doylestown, Penasylvania
Dear
Reference your unidentified observation of 15 November 1966.
The information which we have received is not sufficient for
evaluation.I Request you complete the attached FTD Form 164
and return it in the envelope provided.
We wish to thank you for reporting your observation to the
Air Force.
Sincerely,