PROJECT BLUE BOOK

1. NUMBER OF OBJECTS
1
5. LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS
1 hour 15 minutes
b. TYPE OF OBSERVATION
Ground Visual SEE CASE FILE
7. COURSE
E - NW .
8. PHOTOS
n Yes
X No
9. PHYSICAL EVIDENCE
n Yos Yos
No
FORM
FTD SEP 63 0-329 (TDE) FTD SEP 63 0-329 (TDE) Previous editions of this form may be used.
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34. Date you completed this questionnaire:
Day Month Year
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.
fuxil destauae
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1
I

DEPARYMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AF3C)
WRIGHT.PATTZRSON AIR FORCE BABE. OHIO 45433
49une6?
REPLY TO TDET/UFO Jautiorn, Chio
ATTN OF
5/02152
SUBJECT UFO vation , 4 June 1967 JUN 2 1 1967
TO
Fairbo Ohio 45324
Reference your unidentified observation. The information which
we have received is not sufficient for a scientific evaluation.
the envelope provided. Thank you for reporting your observation
to the Air Force.
JAMES C. MANATT, COlOnel, USAF JAMES C. MANATT, ColOnel, USAF 1 Atch 1 Atch
Director Director ology and Subsystems and Subsystems FTD Form 164 w/envelope
AO PM MO O
CO OM TO ON/AL

DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOREIGN TECHNOLOGY DIVISION (AFSC)
WRIGHT-PATTERSON AIN FORCE OHI0 43433
REPLY TO TDET/UFO
ATTN OF
UFO Observation, 4 Jume 1967 JUN 2 1 1967
SUBJECT
Fairborn, Chio 45424
Reference your unidentified observation. The information which
we have received is not sufficient for a scientific eveluation.
Request you complete the attached FTD Form 164 and return it in
the envelope provided. Thank you for reporting your observation
to the Air Force.
JAMES C. MANATT, COlOnel, USAF JAMES C. MANATT, Colonel, USAF 1 Atch
Director Subsystems FTD Form 164 w/envelope
CO BM TI /IIN
ITO O/I
I

OD Rt
U.S. AIR FORCE 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 poses. Your name will not be used in connection with any statements,
conclusions, or publicat tions without your permission. We request thi: personal information so
that if it is deemed necessary, ,we may contact you for further details.
When did you see the object? Time of day: 21 13
Hour Minutes
4 JUN 67
(Circle One): A.M. or P.M.
Day Month Year
3. Time Zone:
(Circle One): Eastern (Circle One): a. Daylight Saving (Circle One): a. Daylight Saving
b. Central b. o. Standard
c. Mountain
d. Pacific
e. Other
4.Where were you when you saw the object? 4. Where were you when you saw the object?
CHTHELe seNed CHrHzlie seNed FARBOKN FARBOEN O NL0 O Med0
Nearest Postal Address Nearest Postal Address City or Town State or County
5. How long was object in sight? (Total Duration) 1 15
Hours Minutes Seconds
0. Certain c. Not very sure
b. Fairly certain d. Just a guess
5.1 How was time in sight determined?
5.2 Was object in sight continuously? Yes NoK
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. In front of you d. To your left
b. In back of you e. Overheed
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):
g None a. Bright moonlight
b) A few b. Dull moonlight
c. Many c. No moonlight - pitch dark
d. Don't remember
9. What were the weather conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky X a. Dry
b. Hazy b. Fog, mist, or light rain
c. Scattered clouds Moderate or heavy rain
d. Thick or heavy clouds Snow
e. Don't remember
0. The object appeared: (Circle One): 10. The object appeared: (Circle One):
a. Solid a. Solid d.As a light
b. b. 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 c. About the same
D. Dimmer d. Don't know
11.1 Compare brightness to some common object:
Lielt
1.The edges of the object were:
(Circle One): Fuzzy or blurred e. Other
by 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 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
3. Flash or flicker? Yes No Don't know
h. Disappear and reuppear? Yes No Don't know

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Did the object disappear while you were watching it? If so, how?
Went kehint elons X
Did the bject move behind something a any ti particularly a cloud?
(Circle One): Yes A 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 Cp Don't Know. IF you answered YES, then tell what
in front of:
.Tell in a few words the following things about the object: 17. Tell in a few words the following things about the object:
a. Sound_ a. Sound NL N
b. Color Whik Whike
. We wish to know the angular size. Hold a match stick at arm's length in line with a known object arid note how 18. We wish to know the angular size. Hold a match stick at arm's length in line with a known object arid 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 cbject would have been covered by the match head? sighting, how mnuch of the object would have been covered by the match head?
N/A
1. 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.
D00

(Circle One) Yes No
IF you answered YES then what speed would you estimate?
(Circle One) Yes No
IF you answered YES, then how far away would you say
22. Where were you located when you saw the object? Were you (Circle One)
(Circle One):
a In the business section of a city?
aInside a building b, In the residential section of 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 open country?
f. Other g. Other
24. IF you were MOVINGI 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.
a. Eyeglasses e. Binoculars Yes No
b. Sun glasses Yes f. Telescope Yes No
c. Windshield Yes No g. Theodolite Yes No-
d. Window glass Yes No h. Other
26. In order that you can give as clear a picture as possible of what you saw, dascribe 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
Thre. lighio, af Jotincd

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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
90° B
75°
60°
B
NE
30°
A
-15° SW 36
S
A
2. IF there was MORE THAN ONE object, then how many were there?
Draw a picture of ho ywere arranged, and put an arrow to show the direction that they were traveling.
000

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 of Circle One) Yes No
31.2 Please list their names and addresses:
FARBORO
EDR
Li
Please give the following information about yourself: e Yollowir
NAME NAME
Last Name Last Namo First Name Middle Name
ADDRESS FAIEORN FAIREORN 0H10 0H1O
Streat City City Zone State
TELE AGE AGE SEX SEX F
Indicate any additional information about yourself, luding any special experience, which might be pertinent. which micht he pertinent
324
Y
.When and to whom did you report that you had seen the object?
19
Day Month Your
.