( i . DATE TIME GROUP :.. SOURCE I Ci v-:i lian 14. NUMBER OF OBJECTS 15. LeNGTH OF OBSERVAT ION :.:ot R!oortcd 6. TYPE OF OBSERVATION l 7. COURSE J . PHOTOS , 9. PHYSICAL E VIDENCE PROJECT 10073 RECORD 2. LOCATION J~cksonvillc, Pennsylvania (1 \'litness) 10. CONCLUSION INSUFFICD-l'!T IJ,\TA FOH !:VJ\LUATION 11. BRIEF SUMMARY AND ANAL YSlS ReCJlHH:;t fnr complcticn of FTO Fonn 164 was made. contaet. .'ldurc!>~H:l!. Hf"t,un1Cd (NO SUCII ADDTlliSS) Unabl e to U.S. AIR FORCE TECHNICAL INFORMATION This questionnaire has been prepared so that you con g ive th e U.S. Air Force as much information as possible concerning the unidentified aerial phenomenon that you hove observed. Please try to answer as many questions as you fiOSsibly con. The information that you give will b e use d for research purposes. Your nome will not be used in connection with a n y state ments, conclusions, o r publications without your permission. We request this per sonal information so that if it is deemed necessary, we may contact you for further details. 1. When d id you see the obje c t ? Hour Mi nut&s (Circle One): Doy Month Yaor 3. 7ime Zone 'C, rcfe One ) o . Eastern ( Ci rcle One): a. Daylight Saving b. Central b. ""'!!te ...,ere voJ whe n '0'J sew tne object? ! ~e<HotSI P~$i!:l .\o:::d..,s' c ry O t Tow n Sto.r& Ot Cauntv f 5 . -pw long was ')Cjecr n stghr? {Total Durcnon1 Hours Minut~ s s .. conds a . \...erta 1n c. Nor very sure b. Fair ly certcin d . Justo guess 5.2 Was ob1ec in sight contin uously? .S. Whet ""OS -h~ cond tttcn of rh e sky? ;3, Bright b. C l oudy Yes No---- lr '/OU sow th ~ :>b ject during DAYLIGHT, where was the SUN iocared as you looked o t the o bj ect? {Circle One): o. In front of you d. To your left b. In back d you e. Overhead c. To your , ght f. Don't remember 8. IF you saw the object at NIGHT, what did y o u notice concerning the STARS and MOON? 8. 1 STARS (Circle One): MOON (Circle One): a . None a. Bright moon I i ght Dull moonlight c . No moonlight-pitch dark Don't remember d. Don't remember 9. '!Yhot were the weather conditions at the time you sow the object? CLOUDS (Circle Ore i: WEATHER (Circle One): a. Clear sky b. Fog, mist, or I ight rain -.:. Scattered c I oud s c. Moderate or heavy rain -1. Thick or heavy clouds d. Snow e. Don't remember '1e ob1ect appeared: ( C ircle One): T roil sporen t d. As a l ight e. Don't remember : t :1ooeored a s a light. was 1r b r ighter than t he brightest stars? (Circle One): o. tjrrg!1t~r b. Dimr.-er c. About the same d. Don'r know omoore :>n;htness ro .>orre common obJect ( C irc/e One ): o. Fuzzy or blurred !:::. L lke a br ht star c. Sharply outline d d. Don't remember Did the object: a. Aocecr to stand still at any time? b. Suddenly speed up and r ush away at any t ime? c. Breci( up into ports or e.xolode? -:1. Give ofi smoke? e. C!-:onge ~rightness? r. Change !:>hope? F lash o r 'licbr? h. 0 isapoe o r or.d reappear? (Circle One for ecch question) Don't -know Don' t know Don't know Don't know Don't know on t 1<now Don't know In th e follow1ng sketch, imagine that you ore a t the point s hown. Place on "A" on the curved line to show h ow j h igh the object wa s above the hor i zon (skylin e ) when you firs t sow it. Place 'J "8" on the some curved l1ne t o show how h igh the objec t was above th e hor i z on (skyline) when you lost sow it. Place on "A" on th~ c ompass you frrst sow it. Place o "B" on the compass where you last sow the o bje ct. ~trow o p 1c n .. e thct wd l S '"l::>w he mot io n tt..or th e obte c t o r ob jects nr.~de. Pla c e o n 'A" ot t h e beg:n., i.,g of tl.,e :>':ltn, a ' ' B' Jt h~ end ::>r -..,~ o a th, ond s h o"" cr.y change s 1n direc t ior Juri n9 rl,e ,_o.Jr se . =-tne re wcs ORE T-'.XN JNE object, r-:en ; ow ma ny were there? )row o pictu re of ow h e y were arranged, ond out on arrow to show the d1rec n on r'1nr t'-le y were t ravt- .,q, 30. rlo'e you ever seen this, or a similar object before. If so give date or dates and location. -h-s anyone else w i t h you at the t i me you sow the object? ( Circle One) 31.1 IF you answered YES, did they see the object too? (Circle One) I 31.2 Please I i s t tne i r names and addresses: :!'2. p,,~:.:;d g tv e the followtng information abour yourself: l o s t "o-ne F irst Name Middle Nom& City Zon.. Stat& .. o ,:::J' e lny .=:Hilt onol t:-;:-cr')n abou t yours<!lf, r'lclud ing any special expertence , Hhich migh,t be peni n ent 23 . t'fr~r r:1d to w "lom .,:id you reoort that you hod seen the object? Mont h Y!'!Jor MMO ROUTING I SEVER USE POR APPRO~'tll.St DI SAPPROV.iLS, COS CURRENCE::>, OR SJJJ LAR ACTION::> ~P~ DO Form 94, I Feb SO &lld DO Form 9~. 1 Feb SO wbicb will be used until ezbauated. tllfi TI AlS CI"CUL.4Tl COOROIHo\TIO H IH,ORMo\TION SIGHo\TURl FTD (TDEW) Wright-Patterson ~VB, Ohio 45433 Jacksonville, Pennsy1 vania Re~erence your recent unidentified observation which you reported to the ~ty Ofi'icer e.t Wright-Patterson AFB, Ohio on 20 June 1966. '!he infol'll&tion vhich we have received is r:ot sufficient for evaluation. Request you CDmplete the attached FTD Form 164 and return it in the envelope provided. We wish to thank you for reporting your observation to the Air Sincerely, HECTOR QUIN'l'Ai'UI.LA, Jr, :~jor Chief, Projec~ Blue Book FlO (TO EW/ ) WRIGHT-PATTERSON AFB, OHIO UNITED SlATES AIR FORCE POSTAGE AND F EES PAID AIR ~1t~All Jacksonville, Pennsyl vnrd o. FTD JUL 61 383