PROJECT BLUE BOOK

PNOJE ~XEOOXD
DATE. TIME CROUP . LOCATION
TLOCE Me. Aubuen)
3. SOURCE 10. CONCLUSION
.. NUMBER OF OSJECTS NUMBER OF OBJECTS No date presented te No date Dresented te Indieace ob,eet could not havs tee. indieate obect could not havs tee
i airerafe. airerafe.
". LENGTH OF OBSERVATION LENGTH OF OBSERVATION T1. BRIEF SUMMARY AND ANALYSIS 11. BRIEF SUMMARY AND ANALYSIS
10 misrcos 10 miercos Oojeot resemoled a Eod watt bulo at a close distince. Oojoot resemsled a Eot watt bulo at a close distrnce.
in color. Objeut had exhaust sratis in rod and crucn dol in color. Object had exhaust tratis in rod and crton 361
TYPE OF OBSERVATION Observer stated cbject diseppeared and unen recppcared e. Observer stated cbject diseppeared and unen 1 recpoelred .e
Croind Vis.al Groend Vis.al
. COURSE 7. COURSE
1-25.
PHOTOS
5 Yes
No
7. PHYSIC. EVIDENCE
. You
" No
FCRM
T5 SEP 63 0-329 (TDE) Previoua editions of thie form may bo used.
"

This questionnaire has boen propare
information as poss concerning the unidontified carial phonomanon that you have obsorved.
Plaase try to an any questions as you possibly can. The information that you give will
be used for researc osax nama will not bo usad in connection with any statoments,
conclusions, or publicat s without your permission. We request this parsonal information so
that if it is doemad we may contact you for further dotails.
.When did you see the object? 2. Time of day:
Hour Minutes
Sn July 1967 (Circle One):
A.M. or P.M.
Day Month Yoar
3. Time Zone:
(Circle One): Eastern (Circle Ona): a. Doylight Soving
6 Central Standard
c. Mountain
d. Pacific
e. Other
4. Where were you when you sow the object?
CAHB d
Nearest Postal Address City or Town City Or Town State or County State or Counry
5. How long was object in sight? (Total Duratian)
Hours Minutes Seconds
a. Certain c. Not vary sure
Fairly cortain
5.1 How was time in sight determined?
5.2 Was object in sight continuously? Yes No.
What was the condition of the sky?
DAY NIGHT
o. Bright
b. Cloudy b. Cloudy
7. IF you sow the object during DAYLIGHT, whare was the SUN located as you looked at the object?
+
(Circls Ono): a. in front of you d. To your left
b. in bock of you o. Overheod
c. To your right f. Don't remomber
FORM Reproduced by Library of Congress, Legislative Reference Service
OCT 62 164 This iorm superardes FTo 1s4, Ju: 61, whieh is obyolvte. May 1966

Poge 2
8. IF you saw the object at NlGHT, what did you norice co-cerning the STARS and MOON? 1
8.1 STARS (Circle Ore): 8.2 MO)ON (Circle One): -
a. None a. Bright moonlight
b. A few b. Dull monnlight
c. Many c. No moonlight - pitch dark
d Don't remember d. Don't remembar
9. What were the weather sonditions at the time you sow object?
CLOUDS (Circle Om): WEATHER (Circle One): - .
a. Clear sky G. ) Dry
b. Hazy . Fog, ist, or light rain
c. Scattered cloud- c. Moderat- or heavy rain .
d. Thick or heavy c'ouds d. Snow
e. Don': romember
.
10. The object appeared: (Cirele One):
a. Solid Asa light
b. Transparent e. Don't remember
c. Vapor
(Circle One):
0. Brighter c. About the some
b. Dimmer d. Don't know
200 Wot Bo
11.1 Compare brightmass ro,3oma common object: ect:
1.The edges of the obiect were:
(Circle One): Fuzry or blurred Other -
b. Like bright stor
c. Sharply ourlined
d. Dor' remember
13. Did the object: (Circle One for each question)
c. Appear to stand still nt any time? Yes. No Don't know
b. Suddenly speed up and rush awoy ot any time? Yes No Don't know
c. Break up into parts r explode? Yrs No Don't know
d. Give off smokn? Yns No Don't know
o. Change brightaess? Yes No Don't know
f. Change shape? Y n5 No Don't know
9. Flash or flicker? No Don't know
h. Disappear and reappeer? No Don't know

Pag 3
14. Did the object disappear while you were watching it? If so, how?
15. Did the object move behind something ot any time, particularly a cloud?
(Circle One): Yes No Don't Know. IF you answered YES, then tell what
it moved behind:
16. Did the object move in front of something at any time, particularly a cloud? I
(Circle One): Yes No Don't Know. IF you answered YES, then tell what
in front of:
i7. Tell in a few words the following things about the object:
a. Sound
18. We wish to know the angular size. Hold a match stick at arm's length in line with a known object and note how
much of the object is covered by the head of the match. If you had performed this experiment at the time of the
! sighting, how much of the object would have been covered by the match head?
? 1
Usar
_
. 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 espacially exhaust trails or vapor trails.
Place an crrow beside the drawing to show the direction the objeci was moving.
ExhT .
LGrc

1F you enswered YEs, then what spead would you estinare? 211252
2). Cu you think you con estimete how for away from you the objocr was?
('Crele Om (r No
22. Where were you Ineuind when you stw the objeer? 23. Were you (Cirele One)
(Cirele Ore)
o. In the business section of a city?
o. inside a building b. in the residential secrion of a city?
b. in a car in open ceontryside?
②Cutdoors d. Near an airfleld?
d. In an airplone (type) o. Flying ower a dity?
e. Ar sea 6. Flying over open country? i, ying over open country
Other g.
24. IF you were MOV.NG IN AN AUTOmOBiLE or other vehicle of the tima, then complete the following questions: 24. IF you were MOV.NG IN AN AUTOmOBiLE or other vehicle ot the tima, then complete the following questions:
24.1 What direcrion were you moving? (Circle One) 24.1 Whbt direcrion were you moving? (Cirele One)
a. North c. East e. South g. g. West
6. Nartheast d. Southeost 1. Southwest h. h. Northwest
24.2 24.2 How fost wore vou moving? -. How fast wore vou moving? - miles per hour. miles per hour.
24.3 Did you stop at ony time while you were looking at she objecr?
(Circle One) Yes No
25. D'd you observe the ohjetr rhrough any of the following?
h. Eyeglosses Ye5 e. Binoculars Yes
Sun glasses Yes % L. Telaseope C
Windshield 9. Theodalite Yes
Window glans Y h. Other2LESvos
26. in order thot r  an sive as clear a picture os pessible of what you sow, describe in your own words o common
chjeer or oblucts which, when plaerd wo in the sky, would give the sume appearancs us the object which you saw.

"on the compass
90 75° 4
60
NG
30-A A
15° SW
S
Draw a picture that will show the motion that the object or objects mads. Place an "A" at the beginning of the
path, a "B" at the end of the path, and slun uny changes in direction during the course.
A A-3 Towvard Toward 15. B
Fran US
29. IF there was MORE THAN .ONE object, then how many were there? _
Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.
There wereNo MoP=

31.l If you answered YEs, did they ses the object too? (Circle One) 3 No
Pdlgase list their nomes and addresses
oit
3.Plause give the following information about yourself:
NAME
me Middle Nome
ADDRESS ADDRESS BF R CoBr CroBr
Street City City Zone Zore Srote Srote
TELEPHONE NI TELEPHONE NUN AGE 3 AGE SEX
Indisote any additional information about yourself, including any special axperience, which might be perrinent.
Lbe
.
4
yo and to whom did you report thar you had sran the object?
1232
Dar Month Yoar
-

Pago 7
34. Dato you com nis questionnaire: 1%67
Day Month Yeur
.Information which you feel pertinent and which is not adequately covered in the specific points of th
.
c2 eter
G
:
:
-
No
I