PROJECT BLUE BOOK

4.
PROJECT 10S73 RECORD
1. DATE TIME C:OUP 2. LOCATION
26 Feb 67 27/03102 Bellwood, Illinois (2 witnesses)
.sO: /
3. SOURCE 10. CONCLUSION 10. CONCLUSION
Civilian Civilian Astro (s/P)t Astro (S/P) tork Avork
Very Very 700
4. NUMBER OF OF OBJECTS OBJECTS
2
5. LENGTH OF OBSERVATION 5. LENGTH OF OSSERVATION 11. BRIEF SUMMARY AND ANALYSIS
3 minutes Object appeared as a christmas tree light blinking. Object appcared as a christmas tree light blinking. Obsever Obsever
stated aftel watching objectnfor awhile object appeared to
6. TYPE OF OBSERVATION start jumping around.
Grownd-Visual
7. COURSE
South-Southeast
8. PHOTOS
D Yes
No
. PHYSICAL VIDENCE
i7 Yes
XX No
FORM
FTD SEP 63 0-329 (TDE) Previous editions of thia form may be ueed.
11

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THE LISAAKY THE LISAAKY 0E 01E UG-633SP109
LECISLATIVE UPSE thet theit
SSRVIZEEACTSR 1U0C
Belloood,
6010
or UFOLOGY CLUB OF CHICAGE
%0 Joha % Joha1 Hallman Secretary Secretary
1046 Linden Ave. 1046 Linden Ave.
Bellwood Ids 60104 Bellwood Illinds 60194

U.S. AIR FORCE TECHNICAL INFORMATION f raw obpet
Chsappiond
1
This quostionnaire has been preparod so that you can give the-ti.S. Air Forco as much
information as possib concorning the unidontifiad aarial phenomenon that you have obsorvad.
Ploaso try to answer r as many quastions as you possibly can. The information that you give will
be used fer research purposes. Your name will not bo used in connoction with any statomants,
conclusions, or publications without your pormission. Wo roquast this parsonal information so
that if it is deemed necessory, we may contact you for further dotails.
.
1. When did you see the object? .Time cf day:- 9 10
Hour Minutas
26 Feb. 1961 (Circle Ona): P.M.
A.M or
Day Month Yoar
3. Time Zone:
(Circle One): a. Eoster (Circle Ona): a. Daylight Soving
(b. Central b. Standard
c. c. Mountain
d. Pacific d. Pacific
e. Other
4. Where were you when you saw the cojoct?
Beleod
Noarest Postal Address City or Town State or County
.How long wes Total Duration) 3
Hours Minuras Sucands
a. Certain c. Not vary sure
b. Fairly cortoin d. Just a guess
5.2 Was object in sight continuously? YesX No.
6.What was the condition of the sky?
DAY DAY NIGHT NIGHT
o. Briget G.Bright
b. Cloudy b. Cloudy
7. IF you sow the object during DaYLloh'T, where was the SUN located as you looked at the object? 7. IF you sow the object during DaYLiGh'T, where was the SUN located as you looked at the object?
(Circle Ona): a. In front of you (Circle Ona): a. in front of you To your lofe To your lofe
b. In back of you 2. Ovorhoad Ovorhoad
c. c. To your ricnt To your right Don't remembar Dou't ranarober
FORM Reproduced by Library or Congress, Legislative Reference Service
FTD OCT 62 164 Thie form supernedos F'TD 164, Jul 6i, hie s obsolete. May 1966

Poge 2
HT, what did you notice co-cerning th STARS ond MOON?
-~ 8.1 STARS (Circle Ore): 8.2 MOON(Circle One): i
None a. Bright moanlight
b. A few b. Dull monnlight
c. Mony c. No moonlight - pitch dark
d. Don't remember 8. Don't romember
.What were ditions at the time you saw object?
CLOUDS(C.rele On): WEATHER (Circle One):
a. Clear sky a. Dry F.coo
b. Hazy b. Fog, mist, or light rain
Scatteres cloud- c. Moderatr or heavy rain …
d. Thick or heovy c'ouds Snow
e. Don': remember
.
10. The object cobeared: (Cirela One):
(Circle One): a. Fuzry ar blurred Other.
Bikbrightsro
c. Sharely outhines c. Srarp'y cuthines
d. Dor' remember d. Dor' remember
Did the objecr: 1.Did the objecr: (Circle One for ecch question) (Circle One for each question)
a. a. Appear to stand still ay ony rime? Appear to stan still m? ony rime? Yes No Don't know ,
b. Suddenly speed up and rush away at any time? Suddenly speed up and rush away at any time? Y'rs Y'as No Don't know Don't know
c. c. Break uo into parts or exolode? Yrs Yrs No Don't know
d. Give off smoi-? Give off smei-? Y9S Y4S No Don't know
e. Change brishmoss? Change brighmoss? Yes No Don't know
f. Change shope? Yn3 No Don't know
g. Flash or flicke:? es No Don't know
h. Disappear ond rrappecr? es No Don't know

Png3
14. Did the object disappoar while you were watching it? If so, how?
?
.
15. Did the abject move behind something at any time, particularly a cloud?
(Circle One): Yo Know. IF you answered YES, then tell what
it moved behind: _A
1. 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 oí; _..
t i 17. Tell in a few words the following things about the object:
a. Sound
i 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 ob ject 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?
all -...
1. Draw a picture that will show the shope of the object or objects. Labal and include in your sketch any details
of the object thar you saw such as wings, protrusions, etc., and especially exhaust trails or vapor trails.
Place an arrew beside the drawing to show the direction the objeci was movi
s1 oN inglldirections
- F
t V
KYopor
V aportr

(Circle One) Yos No)
IF you answered YES, then whan speed would you estimate? _
.
2. Do you think you can estimere how for away from you the object was?
(Cirele One) Yos No
22. Where were you located when you sow the ohject? 23. Were you (Circle One)
(Circle One):
a. Inside a building o. In the business section of a city?
b. In a car b. In the residential section of a city?.
c. Outdoors C. in open countryside?
d. In un airplone (rype) d. Neer an mrtield?
e. Arseo e. Flying ovor a city?
f. Other - f. Flying qvor opon country?
g. Other l. h.
Xma tre ant blinkine
held at noth
"

.
Pago 5
. In the following skotch, imagino 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 "A"
when you firs! saw it. Place a "B" on the compass whare you last saw the object.
90 .
75-
ww NG
: t t
15• 15°
I 28. Draw a pictre that will show the motion that the object or objects made. Place an "A" th boginning of the
. .~--
-
...
2. IF there wes MORE THAN ONE object, then how many were there?
Draw a plcture of how they were arranged, and put an crrow to show tho
Appe and
1ST started
slow ↓ orownd

Pago 5
2. In the following skotch, imagine that you are at the point shown. Place an "A" on the curved line to show how
high tho object was above tho horizon (skylina) when you first saw it. Place a "B"" on the same curved line to
show how high the object was above tho horizon (skyline) when you last saw it. Place an "A" on the compass
: whon you first sow it. Place a "B" on the compass where you last saw the objact.
90. . .
750
WW NG
C 1
-.* -15
2.Drow a picture that will show the motion that the object or objects made. Place an "A' "at the boginning of the
path, a "B at the end of the path, and sliuw any changes in direction during the course.
2. IF there was MORE THAN ONE object, then how many ware there?
Draw a pieture of how they were arranged, and put an orrow to show the direction that thoy were traveling.
c1 and
1ST31 started
Jumpine
slow ↓ oreunt

30. Hove you ever see
/
31. Nas anyane rlse with you ot the time you saw the object? (Circle One) Y
31.1 IF you onswered YES, did they see the object too? (Circlo (One) Yes) No
31 2 Plaase ist their names and addrosses:
TH.
Dell
33. Plense give the fo foliowing information about yourself:
NAME
Last Name Middis roma
res identof the UFOLOGY
M SF CHICAGO
CLUB
1
.
3. 3.
Mh 1967 Mch 1967
Day Day Morth Year Yesr

Pago 7
4. Date you co this quastionnaire: Larc
Doy Monih Yeur
1
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. questionnaire or a narrative explanation of your sighting.
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