1. DATE TIWE GAOUP July 1 (Dusk) ~. NUWIER OF OIJECTS S. LENGTH 0, OIS!ItVATION 6. TYPE OF OBSERVATION -:rourrl-liJ1lC.l 9. PHYSICAL EVIDENC! 2. LOCATION e\1 Je.r:s 10. CONCLUSION Asj;mn&.ldc3.l (STJ ... ~PL..W) -- .A NO ANALYSIS ~ree cbjucts i:1 .:..r t!a .rher~ ~:e three tli._'r :r-:;1t ol-:>t:a, rd, .iilite, :'rc :J.11e. :hese o';)j.Jcts ti:re c!_i. :-1~r th:.n ::rt<:.rs . Jbj e ct.:> 30. Have you ever seen this, or a s imi lar object before. If so g ive date or dates and location 31. Was anyone else with you at the time you sow the object? (Circle One) 31.1 IF you answered YES, did thy see the object too? (Circle One) 31.2 Please list their n,1mes and addresses: 32. Please give the following information about yourtelf: TELEPHONE NUMBE 1.-dicate any additional information about yourself, inc:luding any special experience, which might be pertinent. 33. Whtn and to whom did you report that you hod seen the object? Month Yeer 34. Date you completed this questionnaire: 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 C-z 1 t-c.l/ J) (L,j J Vt,y? I(} otO:r tt ()(: ..AJ f J.Y r.A<:. JT. F.rD (TDEW) Wright-Pntterson AYB, Ob1o 45433 Ref'erence 1f:AJr obaex vat1cma ot tm1dent~ed t.l.y1.na objec:ta. IZl )GO,&r letter~ 8 ~ 1965 104 d14 not gin att1cient information tor evaluation. 'Dw!rdore, it is requeated that )'Ql fill cut tbe attaehed ri1J ?om 1.64 8Dd return 1 t in tbe enYe lope provided, 1n order tl't w my arke an evaluation. 'the .Air Force appreciates JQr interest 1n tbia subJect HEC'IDR I Jr Chi~, ProJect Blue Book 2. Return Envelope U.S. AIR FORCE TECHNICAL INFORMATION This questionnai re has been prepared so tha t you can give th e U.S. Air Force as much information as possible concerning the unidenti f ied aerial phenomenon that you have observed. Please try to answer as many questions as you possibly can. T he information that you give will be used for research purposes. Your name will not be used in connection with any statements, conclusions, or publications without your permission. We request this persona l information so that if it is deemed necessary, we may contact you for further details. 1. When did you see the object? (Circle One): or, Day Month Ysar 3. T i me Zone: a. Eastern b. -eentrol a. Daylight Saving b. Standard (Circle One): (Circle One): c. Mountai n 4. Where were you when you saw the object? Nearest Postal Adaress Ci t y or Town State Of County 5. How long was object in sight? (Total Duration) Hours Mi nutes 6. What was the condition of the sky? a . Bright c. Not very sure Just a ~eu a . Bright. 7. IF you saw the object during DAYLIGHT, where was the SUN located as ~,.,u looked at the object? ( Circ:le One): a. In front of you b. In bock of you c. To your right d. To your left e. Oviitrheod f. Don't remember Thh fMm u p e red .. FTD 1114, J u l bl. 'Nhlch I a o b ole t e . 8. IF you saw the object at NIGHT, what did you notice concerning the STARS and MOON? 8.1 STARS (C ircle One): MOON (Circle One): 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 yoo saw the object? CLOUDS (Circle One): WEATHER (Circle One): a. ~lear iky b. Fog, mist, or light rain c. Scattered clouds c. Moderate or heavy rain d. Thick or heovy clouds d. Snow e, Don't remember 10. The object appeared: ( Circle One): d. As a ligh-t Transparent e. Don't remember 11. If i t appeared as a light, was it br ighter than the br ightest stars? (C ircle One): a. Brighter c. About the same d. Don't know Compare br ightness to some common obje c t : 12. The edges of th e object were: (Circle One): a. Fuzzy or blurred b. Like a bright star c. Sharply outlined \ d. Don't remember Did the object: Appear to stand still at any time? b. Suddenly speed up and rush away at any t ime? c. Break u p into ports or explode? d. Give off smoke? Change brightness? f. Change shape? Flash or fl icker? Disappear and reappear? (Circle One for each question) Don't know Don't know,. Don't know Don't know Don't know Don't know Don't know Don't know Did the object d isappear while you were watching it? If so, how? Did the object move behind so~ething at any time, particularly a cloud? (Circle One): Don't Know: -/-IF you o/ered YES, then tell what it moved behind: Did the object move in front of something at any time, particularly a cloud? (Circle One): Don't Know. IF you answered YES, then tell what in front of: Tell in a few wotds the following things ~t the object: We wish to know the angular size. Hold a match stick at arm's length in fine with a known object and note now much of the object is covered by the head of the match. If you had performed this experiment at the time of the sighting, haw much of the object would hove been covered by the match head? Draw a picture that will show the shape of the object or objects. Lobel and include in your sketch any details of the object that y o u saw such as wings, protrusions, etc., and especiatly exhaus t trail s or vapor trails. Place an arrow beside the drawing to show the direction the object was moving. 20. Do you think you con estimate the speed of the object? (Circle One) IF you answered YES, then what speed would you estimate?------- 21. Do you think you can estimate how far away from you the object was? (Circle One) IF you answered YES, then how far away would you say it was?--------- 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. West b. Northeast d. Southeast f. Southwest h. Northwest 24.2 How fast were yO() moving?---------' i le 1 per hour. 24.3 Did you stop at any time while you were looking at the object? (Circle One) Yes No Did you observe the object through any of the following? Eyeglasses Yes e. Binoculars . Yes No Sun glasses Yes No f. Telescope Yes No Windshield Theodolite Window glass 26. In order tnat 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 plac:ed up in the sky, would give tne same appearance os tne object which you saw 27. In the following sketch, imagine that you are at the point shown. Place an "A'' on the curved line to show how the object was above the horizon (skyline) whe n you first saw it. Place a "B" on the same curved l ine to show how high the object was above the horizon {skyline) when you lost sow it. Place un "A" on the compass when you first sow it. Place a "B" on the compass where you lost sow the object. 28. Oraw a picture that wi ll show the motion thor the object or objects mode. Place on " A" at the beginning of the parh, a "B" at the end of the path, and show on)' changes in direction during the..cour~e. 29. IF there was MORE THAN ONE object, then how many were there? -....:;... --- ------ Draw a picture oi how they were arranged, and put an arrow to show the direction that they were travel ing .