PROJECT BLUE BOOK

PROJECT 10O73 RECORD
1. DATE -TIME GOUP. 2. LOCATION
12 Jul 67 12 Jul 67 12/09452 12/09452 Daytcn, Ohio Daytcn, Ohio - . 1
3. SOURCE 10. CONCLUSION 10. CONCLUSION
Civilian Civilian INSUFFICIENT DATA FC INSUFFICIENT LUATION ATION
4. NUMBER OF OBJECTS Form 164 sent to observer over 60 days ago, when form is
1 1 returned the case the case will be re-evaluated. Ree 2/elief will be re-evaluated. Rec2/ieb6t
S. LENGTH OF OBSERVATION .LENGTH OF OBSERVATION 11. BRIEF SUMMARY AND ANALYSIS
1 minute SEE CASE FILE
6. TYPE OF OBSERVATION .
Ground Visual
7. COURSE /
Not reported
8. PHOTOS
Yos
No
9. PHYSICAL EVIDENCE
Yes
No
FORM
FTD SEP 63 0-329 (TDE) ?'ravioue ditions of thle form may b used.
.
3
.

.
s :
$ny?
.IF you saw the object ot 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
9. What were the weather conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky Dry
b. Hazy b. Hazy b. Fog, mist, or light rain b. Fog, mist, or light rain
Scattered clouds C. Scattered clouds c. Moderate or heavy rain Moderate or heavy rain
d. Thick or heavy clouds Thick or heavy clouds d. Snow
e. Don't remember Don't remember
1. The object appeared: (Circle One): 10. The object appeared: (Circle One):
a. Solid d.As a light
b. Transparent b. Transparent e. Don't remember e. Don't remember
c. Vapor
I. 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:
The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright star
c. 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? Yes Yes No Don't know
b. Suddenly speed up and rush away at any time? Yes No Don't know Don't know
c. c. Break up into parts or explode? Break up into parts or explode? Yes No Don't know
d. Give off smoke? Yes No Don't know Don't know
e. Change brightness? Yes Yes No Don't know Don't know
f. Change shape? Yes Yes No Don't know
g. Flash or flicker? Flash or flicker? Yes Yes Ne Don't know
h. Disappear and reappear? Yes Don't know
.

Page 3
14. Did the obiect
Vi5. 17
nd something at any time, particularly a cloud?
15. Did the obiect
05) No Don't Know. IF you answered YES, then tell what
(Circle One
it moved b
- tont of something at any time, particularly a cloud?
16. Did the obiect
Yes (N\o No Don't Know. IF you answered YES, then tell what
(Circle On- (Circle On-
in front of in front of.
17.Tell in a few Sollowing things about the object:
17.Tell in a few
a. Sound_
=
b. Color
wior size. Hold a match stick at arm's length in line with a known obinct and note hov
18. d by the head of the match. If you had performed this experiment at the time of the
much of the o piect would have been covered by the match head?
sighting, how
sn the shape of the object or objects. Label and include in your sketch any details
1. Draw a picture sch as wings, protrusions, etc., and especially exhaust trails or vapor trails.
of the object r=wing to show the direction the object was moving.
Place an arrew Place an arrow

Page4
20.Do you think you can estimate the speed of the object?
(Circle Ons) Yes N\}$
IF you answered YES, then what speed would you estimate? .
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? _
2. Where were you located when you saw the object? Were you (Circle One)
(Circle One):
a. a. In the business section of a city? In the business section of a city?
a.Inside a building a. Inside a building (6.) (6.) In the residential section of a city?
b.In a car b. In a car c. c. In open countryside?
{c. c.) Outdoors Outdoors d. d. Near an airfield?
d. In an airplane (type) e. Flying over a city?
e. At sea A{ sea f. f. Flying over open country?
f. Other _ f. Other g. Other ._ Other _
24. 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. Wost
b. Northeast d. Southeast f. Southwest h. Northwest
24.2 How fast wers you moving? — miles per hour.
24.3 Did you stop at any time while you were looking at the object?
(Circle One) Yes No
2.Did you observe the object through any of the following?
a. Eyeglasses Yes No e. Binoculars No)
b. Sun glasses No f. Telescope Yes No
c. Windshield Yes "No g. Theodolite Yes No
d. Window glass d. Window glass Yes Yes No No) h. Other h. Other
In ordar that you can give as clear a picture as possible of what you saw, describe in your own words a common 2In ordar that you can give as clear a picture as possible of what you saw, describe in your own words a common
object or objocts which, when placed up in the sky, would give the same appearance as the object which you saw
11
,

high the object was above the horizon (skyline) when you first saw it. Place a "B"" on the sume curved line to
show how high the object was above the horizon (skyline) when you last saw it. Place an "A" on the compass
when you first saw it. Place a "B" on the compass where you last saw the object.
90° 75
_60
NW NB
30
-15° SW S5 SS
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.
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.

Poge 6
30. Hava you aver saen this, or a similar objoct before. if se glve date or dates und locution.
VES, APAANE
31. Was anyone slse with you at the time you saw the object? (Circle One) No
31.1 IF you answared YES, did they see the object too? (Circlo Ona) No
31.2 Please list their names and addresses:
.Please give the following information about yourself: 32. Please give the following information about yourself:
NAME
Last Name First Name Middl Name
ADDRESS DAYTON 45427 ONIO
City Zone State
TELEPHONE NUMBE AGE 13 SEX MALE
Indicate any additional information about yourself, including any special axparience, which might be pertinent.
33.When and to whom did you report that you had sean the object? 33. When and to whom did you report that you had sean the object?
Day Month Yoar
111

PROJECT 10073 RECORD
2 LOCATION
16 Jul 67 16 Jul 67 17/0400z 17/0400Z Dayton, Ohic Dayton, Ohio
3. SODECE . CONCLUSION . CONCLUSION
Civilian Probable (A.RCRAFT Probable (A:RCRAFT)
1. NUMBER OF OBJECTS .NUMBER OF OBJECTS
2
5. LENGTH OF OBSERVATION 5. LENGTH OF OBSERVATION 11. BRIEF SUMMARY ANC ANALYSIS BRIEF SUMMARY ANC ANALYSIS
10 minutes minutes . Observer sti:ted that the object appeared as a light. The
6. TYPE OF OBSERVATION brightness of the chject was campared to that of a star.
Brightness was the about the same. Object's edges
Ground Visual were like those of a bright star. Object had not any
7. COURSE distinct sound of its own. Color: bright light.
Southwest
8. PHOTOS
Yes
No
9. PHYSICAL EVIDENCE
[7 Yos
XNo
FORM
FTD SEP 63 0-329 (TDE) Previoue editions of this form may be used.
3
1
.:

Digitng 816 gu andt 5 Karbe liept
Mayton, Shi
7/03492
17/04002 1
Dayton, Ohio 45410
OCT 1 0 1967
'

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3
Lipt2,1967
O Wgj. Guntanlly gr.
ij
Mp sstio ofrine ane to
Rip quiet
CC
9lnd2 s 2T
0 0 110077. anthel 110079, an7 the n2e the ncon at onat
4o Loth. nebet Af lotRs. oRs.
Aba ndd te te thing thing
. AaTh of then
+
I

It flasted plo not fst ao pane.
Nrth Wto Sat
4
deeat, to late for
9.45 PM. Haith Et Sul
South Close  LivoSicll
notmuchveia Kstmuch in sight 3t 5nn.
bt, hot.
July 23.d. NothE. t SoutEat. Sc
Si
2:
GO7 AM. Nuadln snthistop.

SunthE E. ney ..
for disafard, the diwent away
x high stto
f lefti lft Lein Lein 1571 157 aay C to
( to soithe fout
I an Diling
9100 AM.HaiLWGSith That mde it seem
- tdat ! '
Y and

12Jnly7
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS FOMEIGN TZCHNOLOGY DIVIBION IAFSC)
WRIGHT.P FOXCE BASX.OHIO 45433
REPLY TO TDET/UFO
ATTN OF
20Jul67
SUBJECT UFO Observation 12 July 67
TO
Dayton, Ohio 45427
Reference your unidentiried observation. The information which Reference your unidentiried observation. The information which
we have received is not sufficient for a scientific evaluation.
Request t you complete the attached FTD Form 164 and return it in t you complete the attached FTD Form l64 and return it in
the envelope provided. Thank you for reporting your observation the envelope provided. Thank you for reporting your observation
to the Air Force. to the Air Force.
SAMES C. MANATT, COlOneL, USAF MES C. MANATT, COlOnel, USAF 1 Atch 1 Atch
Birector inology and Subsystems FTD Form 164 w/envelope
N
.
-
4
1

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1

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il Lle A
.
THOREAU
'
U.S.
:

.
Sightings of 16 Joly to Saptember 15"
fornI
U.S. AIR FORCE TECHNICAL INFORMATION 1
This questionnaire has been prepared so that you can give the U.S. Air Force as much
information as concerning the unidentified aerial phenomenon that you have observed.
Please try to ans any qusstions as you possibly can. The information that you give will
be used for research rposes. 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, we may contact you for further details.
When did you see the object? 2Time of dayA/ 4/
Hour Hour Minutes Minutes
B⊥L B,iL 00
1o 1967 1967 (Circle One): (Circle One): A.M. P.M.
or or
Day Month Month Year
3. Time Zone: 3. Time Zone:
(Circle One):a. (Circle One):a. Eastern Eastern (Circle One): (Circle One): a. Daylight Saving a. Daylight Saving
b. Central b. b. Standard
c. C. Mountain
d. Pacific
e. Other
4. Where were you when you saw the object?
Nearest Postal Address City or Town State or County
5. How long was object in sight? (Total Duration) 12
Hours Minutes Seconds
a. 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 X No
6. What was the condition of the sky? 6. What was the condition of the sky?
DAY NIGHT
a. Bright
b. Cloudy
7.IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object? 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 vou (Circle One): a. In front of you d. d. To vour left To your left
b. In back of you e. Overhead
c. To your right f. Don't remember
FTD FORM
OCT 62 164 This form superaedes FTD 164, Jul 61, which is obsolete.
.
'

Poyn ?
8. IF you saw the object at NIGHT, what did you notice concerning the STARS und 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
9. What were the weather conditions at the time you saw the object?
CLOUDS (Circle One): WEATHER (Circle One):
a. Clear sky a. Dry Dry
b. Hazy b. Fog, mist, or light rain
c. Scattered clouds Moderate or heavy rain
d. Thick or heavy clouds d. Snow
. e. Don't remember
10. The object appeared: (Circle One):
a. Solid Solid d. As a 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 same
b. Dimmer d. Don't know
11.1 .Compare brightness to some common object:
No)
12.The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright star
c. Sharply outlined
d. d. Don't remember Don't remember
.Did the object: Did the object: (Circle One for each question)
a. a. Appear to stand still at any time? Appear to stand still at any time? Yes No Don't know
b. Suddenly speed up and rush away at any time? Suddenly speed up and rush away at any time? Yes No Don't know
c. C. Break up into parts or explode? Yes Yes No Don't know
d. Give off smoke? Yes No Don't know Don't know
e, Change brightness? Yes No Don't know
f. Change shape? Change shape? Yes No No Don't know Don't know
g. Flash or flicker? Yes No Don't know
h. Disappear and reappear? Yes No Don't know
.

Page 3
14. Did the object disapper while you ware watching it? If so, how?
Did the object move bahind 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 Don't Know. IF you answered YES, then tell what IF you answered YES, then tell what
in front of: . in front of: _
17. Tell in a few words the following things about the object:
7 a. Sound__ a. Sound _
b. Color_
1. 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 ot the time of the
sighting, how much of the object would have been covered by the match head?
$\}$ onoe
1. Draw a picture that will show the shape of the object or objects. Labe! 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.
Sw SW
20 0 N
abiet nah ae abiat onah as a
Thoeahe ecope Thae ahe scop
it war it wa dark adge, dark adges
5
'

2.Do you think you can ostimate the spoed of the object?
(Circle One) Yes No 7
IF you answered YES, then what speed would you estimate?
1.Do you th ink you can astimate how far away from you the object was?
(Circle One) Yes No
IF you answered YES, than how far away would you say it was? _ 2an
2.Where were you located when you saw the object? 2. Were you (Circle One)
(Circle One):
a. In the business section of a city?
a.Inside a building b. In the residential section of a city?
b.In a car c. In open countryside?
c. Outdoors d. Neor an airfiald?
d.in an airplane (rype) .Flying over a city?
e. At sea Flying over open country?
g. Other _
24. 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. Wost
. 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 Yes No e. Binoculars Yes
b. Sun glasses Yes f. Telescope Yes No
c. Windshield No g. Theodolite Yes
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
object or objects which, when placed up in the sky, would give the same appea earance as the object which you saw.
LFway OCo InSt wae Olo 010021 biyer
2Ra
by thsee-

Paa 5
27. In the following sketch, imagine that you are at the point shown. Place or "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 curved line to
show how high the objact was above the horizon (skyline) when you last saw it. Place an "A"" on the compass
when you first saw it. Place a "B" on the compass where you last saw the object.
90°
60
NW
30B
-15 15 3W 35
ent en
Atwanuf Atwn cutf So.CA Soth
Uraw 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.
A
went straight
IF there was MORE THAN ONE object, then how many were there? _ 2
Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.
A
↓
N 610.48 -10.48
Moor Moov
B B\ N F11:00 F11:00
SE
4

0447-21-2
SW 207 NE-51 (,M-
Yo No
31.1 IF you answered YES, did they sae the object too? (Circle One) $Y_r}$ No
31.2 Ploase list their names and ad
Same addieie on age15
. Please give the following information about yourself: .Please give the following information about yourself:
NAME NAME
Last Name Last Name First Name First Name Middla Name Mic Name
ADDRESS DANTA
Street City Zone State
TELEPHONE NU AGE 33 SEX
Indicate any additional information about yourself, including any special experience, which might be pertinent.
only was a plane watcher wheniN schocl
.WIRKON unidenfied flaves - RepeRtedt WPFB
TheN iN/94f50r46 - Ruth wois Caickmore GTEPU
3.When and to whom did you report that you had seen the object? 33.When and to whom did you report that you had seen the object? NOONES
19 July Jul 67
Day Month Yoar
,

Page 7
34. Date you complated this questiannaire: OcT, 67
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.
Pencnbe 9 a,12 looking t
This red star o0 ajic that ae
with the moo6 to the bower jait tay
3day thin left. 3day thin left. It was never
MOON MOCN kR k R
sden aiicl rdln oel

form I
. (2)
Ctine) 9:50 P.M.
3 Coslen -tine jone
0 (4) Wagne and goning Wa, tor, Ohir, Mont
()20min8g (52) yeu
⑥ Bright
2
Qn (22 ison(Qu 28fu (22 20n(u
(10) as a light. (10) av a light.
1①about the ae -M Morth ita 1①abont the a 4-M Moth ax
d:1 g
13.a no B.2 C. D E.fG
(4) n0.
(5) 20
V Us. went mnden clonide lovist eev sun
one
17 Laund - None
(%)
. 0 (2 Saine a AD. foum I (2 Sine an AtB. forn I
(20) (20) slow alow
QD No No a
(G2) inback Gael (22) in back farel
. ②3) B -ssidintal scZin O
(②4
(25)71dc wt
+
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21te618
U.S.AIR FORCE TECHNICAL INFORMATION
This questionnaine has been prepared so that you can give the U.S. Air Force as much
information as pos oncerning the unidentified aerial phenomenon that you have observed.
Please try to ans The information that you give will
be used for res 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 neces e may contact you for further details.
n:
.When did you see the object? .When did you see the object? Time of day:
Hour Minutes
wid wod (46) 14 (Circle One):
guila A.M. or P.M.
Day Day Month Year Year
3. Time Zone:
(Circle One): tCinas a. Eastern (Circle One): a. Cinnl Daylight Saving
b. Central b. Standard
c. Mountain <
d. Pacific
e. Other
4. Where were you when you saw the object?
Nearest Postal Address City or Town State or County
5. How long was object in sight? (Total Duration)
Hours Minutes Seconds
a. 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 No1
6. What was the condition of the sky? 6. What was the condition of the sky?
DAY NIGHI NIGHI
a. Bright a. Bricht
b. Cloudy b. Cloudy
7. IF you saw the object during DAYLIGHT, where was the SUN located as you looked at the object? 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. Overheod
c. To your right f. Don't remember
111

a
0
ac the his ste Sane as A+B)
(7) 650A - 20^°B NW- SW
0 8.) B A
(2.9) 1 ofjiat
(30) anomered on page with Ais-
31 yes 31D yeu (31.2) Michael Sucy.A
32) Sande a pagel on AtB fonI
(33)NO -J710
34) 0ct. 12,1967
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7
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64) yee -came fom hiy dije Zin engel incange
(5)20
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18) Conered mated dend
19) came a At B fw
20) no-tofut
(22)6in bactyu (22) 6in bactynd
(03 b Reideie setin (03 b Reidedie sctin
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Aam Aamb (D not (1D noti
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(5) no
(16) no
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(8) sigi of iatcl head.
(20) lw to for a ay
(31) 70
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241 241
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27450A-350 NE - SW
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(33) MO
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123 1967 Q10:23 PM
ite awhile about 20 nin
6) Bight night
21.
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34) 12 Dct 1967 3412 002196/
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(G) 7721 VT
2).6074.M.
3'Castontinc
Nayne and Wyoning
0 (5) 25-30min(gu) 4C
(6)
lift but hs't risn yet -
(8) le 82,S0ne
(9.1 ,1j
10 Co adilt (10 Co adilt
(2)blieatei (2) bdike a ate
13/a.20. b no. C.2o. D.22o. E.2lo. £. )o G.20 H.M 0
(4) No,
15) N.
(16) no
(7) none
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(7)
(8) bf En doit iwnt
d.ang Clnide (9 diteany Clnnits A. Nry A. Nry
10 ao a bight 10 ao c hght
(11) (11) abn it e oume aba itie oeme
ak!
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eloude on fodi anoyr
(15) yeu-
(16) 720
18) malhe
09 Same an FormI
(00)o
. (21) n
(22) in Gaect.ynd (22) in Gack.lnd
(3) (23) Risidential section Risiderteal section
0 (24) 124
0 (25) (25) )20 )0
(26 sane ae faI
27 750 90 NW-SE
.

..
.
Pnge ?
8.IF you saw the object at NIGHT, what did you notice concerning the STARS und MOON?
8.1 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 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 a. Dry
b. Hazy b. Fog, mist, or light rain
c. Scattered clouds c. Moderate or heavy rain
Thick or heavy clouds d. Snow Snow
4 e. Don't remember Don't remember
10. The object appeared: (Circle One):
a. Solid Solid d. As a light
b. Transparent e. Don't remember
c. Vapor c. Vapor
1. If it appeared 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:
.The edges of the object were:
(Circle One): a. Fuzzy or blurred e. Other
b. Like a bright star
c. 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? Yes No Don't know
b. b. Suddenly speed up and rush away at any time? Yes Ys No No Don't know
c. Break up into parts or explode? Yes No No Don't know
d. Give off smoke? Yes No Don't know
e. Change brightness? Yes No Don't know Don't know
f. Change shape? Yes No Don't know
g. g. Flash or flicker? Yes Yes No Don't know Don't know
h. h. Disappear and reappear? Disgonegr a aopea? Yes No Don't know Don't know
11
1

38 3A
(29) 1
(30) Same an deimI
31) Same as fmI 0
②2) Samne for I
33) no,
34 12 Oat. 1967
351 Deny high Dery high seem to climb im to elimb
0
0 0
.

I form VII
0 app,
1 O0t 2, 1967 8:00 .P.M
3 Catern time Da
(41)
0 (6) 2min
(6)
(7)
81 8 -Ci -Ci -moonbght
91 alears 9) aaleasy Hhy Hhy
(1) breghter apot light spot light
(2)
0 13a no bno. C.no D.2o.E.no.fno.G.noHin2
(4) 720
(5) no
(16) No.
(7 nooound color light (light)
M Eliean ote
(20) 20
21) No Q2 inbafal. 23 neideti Q2) inba0 Eifarl, 23 nide nt
0 (24)
25) 121 25) 121
(26) Liie a atar -M.Tusey 26) Lir'e a atar -M.Tusey Day
(27) 600 NE (07):600№E 200.510 200 510 NE-SW E
,
(29)
..
".

DayTon,Ohi0
make age 11
33
• addris)oat267
64)12 Qct,(927 (4)12, Qct(927
(35) Zhi
datte to- bymy 0
0
.
.

J form T5
0
DCL (2).2hant8:30PM
2a0n
O
6) pight A. Bright
7
(8)bfe
9 (a)cheairsly C dy 9 (a)clai 0 Dry
"das a lift andsolid Pdas e lift and solid
p1 (a)brightri p1 (a)brightri
(2) C, Sharfly (2) C, Shanfli antliiel antlinel
(3) a)2i0, 6 n0 C.n0. 0.n0 E.n0 720 G.2i0.H.70 (3) a 2i0, 5 nc C. no. 1,no E.no 7 2s G,2i0.1.7s
14 20- (15)20.(6)10.
(5) Ycouer
(19) by eye sight
5.W.E ∠NE
0 .
(20)720(ed.() 20) 720(ned.x) 2056A
Q1l no-very low Q11 No-very lou
. (23)
(24)
(25) ne.
1

I
0
G any abjict 4in by 4in rund
(271 600K 20B. A NE B.SW.
Q8BK A
(29/
(30) Ho-
31) lie. 3 31.1 Ge2 312
(32)
age. 15 age. 15 Mabe O
Been obser
(333 -geaNdmoher
Brothep and
also MiTher NexT doy
Cct4, 1967
Thire
about 10 min al
-
191
,
I

hol
(repiates)
aC(iila
.
O
Ivn miet sinjieztit bm
Cn
0 0
0
1
11

0
(28)
0
B< A
(29) 1022
(30) a fomI entchaiges
(31) yes 205
35) lotin doude halfeage. 10:20
0
a2 thinpaled
to a brigte bifee got lage bifoe got lage
ande abnteineton, Did sist
likean atialand o cortiine to
'

0
(11) July 12,1967 (2) 1020PM-/0:25P.M
(3) Ealin Tiie Dylght Daving
4). Wayne ad Wgon 2
0 (5) no.
(6) night- Clondy- (7)
(8) few nomoo
(9) C. Seatted Clonde a Dry
(10) (10) ) as a ljht )aa
(11) (11) about the sane 1l noth dae about The sane 1l Noth dr
(2) Like 2 ola 12) Like a ola.
(13) A-yes B. y. C. no. D.no. E. ye0 f N Ge (13) A-ges B. y. C. no. D. no. E. yee f no.Gfe.
0 H.yes H. yes
(1^{4 Yes- Whnt ints sone aloud min.
diiection.
(15) 10 (12) n00
12) ded ef match Like aatar
≤W
Nlike a st
0 (20) 220 (20)220 ②1 QD no) N0) Q2) in backbad. 22) an bak bad
(Q3) rloedintialsrcti (23) rloidintialsicti
(Y (GY
(25) (25) )0
. 0 (26 (2W fecartee Geartee
(27) 7504 20°B.
W-E Nlappiaw №-S-
,

0
Q) Oalsl4,107 (2) 2150 R.M.
(3)ti tine Daitdaving
0 e) Woye and Wiping. Day  phib,mont
5) 20min Gue hje
. (6) nigit- Brinlt
. (2) 6
(8) he NoMoon
(9)
(0) as a lirtt
(12) like an bigit Atar
(13)00Mh 11. 21
bytcope igg
Light
21) no
62) in beckod Rsdeatilpction
(24)
10-10

~* *
.
27) A900 B.300 S.E
(28) B *A
29)1
(30) Sane as frm I 0
311 Same as fomT
32) Sane
(33) U N - oct4,1967
(34) 12 0ctarbey 1967 12 Octarbey1967
(5) Zhig (5) thig
0
.
0
B
I

Pnga 3
14. Did the obiect disappeor while you were watching it? If so, how?
If pesst dip
15. Did the obiect move behind somathing at any time, porticularly a cloud?
(Circle One): Yes NO Don't Know. IF you answered YES, then tell what
it moved behind:.
1. Did the obiect moye in front of something ot any time, particularly a cloud? 16. Did the obiect moye in front of something ot any time, particularly a cloud?
(Circle One): Yes Yes No Don't Know. IF you answered YES, then tell what
in front of: .. in front of: ...
17. Tell in a few words the following things about the object:
a. Sound
We wish to know the angular size. Hold a match stick at arm's length in line with a known obiect 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 obiect would have been covered by the match head?
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.

.
Page 4
20. Do you think you can sstimate the spoed of the object?
(Circl 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 it was?
22. Where were you located when you saw the object? 23. Were you (Circle One)
(Circle One):
a. In the business section of a city?
a.Inside a building a. 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. Outdoors Outdo d. Near an airfield? dNear an airfield?
d. d. In an airp In an airplans (type) Slans (type) e. e. Flying over a city?
e. e. At sea f. Flying over open country?
f. Other - Other g. g.
24. 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 t the time, then complete the following questions:
24.1 What direction were you moving? (Circle One)
a. North c. East e. South g. Wast
b. Northeast d. Southeast f. Southwest h. Northwest
24.2 How fast wore 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 observs the object through any of the following?
a. Eyeglasses Yes No 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
.In order that you can give as clear a picture as possible of what you saw, describe in your own words a common
objoct or objocts which, when placed up in the sky, would give the same appearance as the object which you saw.

Pags 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) when you first saw it. Place a "B on the same curved line to
show how high the objoct was above the horizon (skyline) when you last saw it. Place an "A" on the compass
when you first saw it. Place a "B" on the compass where you last saw the object.
90. 73•
60
NW NT
30
-15° 15° Sw SW
LDraw 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.
Draw a picture of how they were arranged, and put an arrow to show the direction that they were traveling.
.
I
1

Pag• 6
30. Have you ever seen this, or a similar object bafore. if so give dote or dates ond location.
7
Was anyone alse with you at the time you saw the object? (Circle One) No
6
31.1 IF you answered YES, did they see the object too? (Circle One) No
31.2 Please list their names and addresses:
32. Please give the following information about yourself: 32. Please give the following informgtion about yourself:
f L
NAME
First Name
ADDRESS
C City Zone Stote
TELEPHONE NUMBE AGE SEX EA
Indicate any additional information about yourself, including any special experience, which might be pertinent.
33. When and to whom did you report thaf you had seen the object? 33. When and to whom did you report thaf you had seen the object?
E
Day Month Yoar
11

I ..
U.S. AIR FORCE TECHNICAL I INFORMATION 1
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 as questions as you possibly can. The information that you give will
be used for research oses. 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, , we may contact you for further details.
B.TF:
When did you see the object? Time of day: 45
mensrd yoo soe me ooletr. Hour Hour Minutes
12 12 JocY J0LY 607
(Circle One): (Circle One): A.M. or F.M. F.M.
Day Day Month Year
3. Time Zone: 3. Time Zone:
(Circle One): a. Eastern (Circle One): a. Doylight Saving
b. Central Central b. Standard b. Standard
c. Mountain
d. Pacific
e. Other
4.Where were you when you saw the object?
DortoN
Nearest Postal Address City or Town State or County
5. How long was object in sight? (Total Duration) ?
Hours Minutes Seconds
a. Certain C. Not
b. Fairly certain
5.1 How was time in sight determined? _
5.2 Was object in sight continuously? Yes No
What was the condition of the sky? 6. What was the condition of the sky?
DAY DAY NIGHT
a. Bright a.Bright
b. Cloudy Cloudy b. Cloudy
IF you sow the object during DAYLIGHT, where was the SUN located as you looked at the object? IF you sow 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. Overhead
c. To your right f. Don't remember
FORM
FTD OCT 62 164 This form supersedes FTD 164, Ju! 61, which is obsolete.