302546314.pdf

FORM

|  1. DATE - TIME GROUP | Dec 65 0730Z  |
| --- | --- |
|  2. LOCATION | La Crosse, Wisconsin  |
|  3. SOURCE | Civilian  |
|  4. NUMBER OF OBJECTS | One  |
|  5. LENGTH OF OBSERVATION | N/A  |
|  6. TYPE OF OBSERVATION | Ground Visual  |
|  7. COURSE | N/A  |
|  8. PHOTOS | ☐ Yes ☑ No  |
|  9. PHYSICAL EVIDENCE | ☐ Yes ☑ No  |
|  10. CONCLUSION | Insufficient data for evaluation.  |
|  11. BRIEF SUMMARY AND ANALYSIS | SEE CASE FILES  |
|  RETURN TO: | Director Aerospace Studies Inst ATTN: Archives Branch Maxwell AFB, Alabama  |

KRH3.6012-1
Dec 1965

LaCrosse, Wisconsin
December 1966

29 Mar 66

FTD (TDEW)
Wright-Patterson AFB, Ohio 45433
10 May 1966

LaCrosse, Wisconsin 54601

Dear Miss [redacted]

Reference your recent unidentified observation. The information which we have received is not sufficient for evaluation. Request you complete the attached FTD Form 164 and return it in the envelope provided.

We wish to thank you for reporting your observation to the Air Force.

Sincerely,

Hector Quintanilla, Jr.
Major, USAF
Chief, Project Blue Book

SHC
1003711

U.S. AIR FORCE TECHNICAL 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 as many questions as you possibly can. The 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 personal information so that if it is deemed necessary, we may contact you for further details.

|  1. When did you see the o…

Page 2

8. IF you saw the object at NIGHT, what did you notice concerning the STARS and MOON?

8.1 STARS (Circle One):
a. None
b. A few
c. Many
d. Don't remember

8.2 MOON (Circle One):
a. Bright moonlight
b. Dull moonlight
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):
a. Clear sky
b. Hazy
c. Scattered clouds
d. Thick or heavy clouds

WEATHER (Circle One):
a. Dry
b. Fog, mist, or light rain
c. Moderate or heavy rain
d. Snow
e. Don't remember

10. The object appeared: (Circle One):
a. Solid
b. Transparen…

Page 3

14. Did the object disappear while you were watching it? If so, how?
No

15. Did the object move behind something at 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?
(Circle One):
☐ Yes ☐ No ☐ Don't Know. IF you answered YES, then tell what in front of: _______________

17. Tell in a few words the following things about the object:
a. Sound _______________
b. Color _______________

18. We wish to know the angular si…

Page 4

20. Do you think you can estimate the speed of the object?
(Circle One) Yes ☐ No ☑
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) 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?
(Circle One):
a. Inside a building
b. In a car
c. Outdoors
d. In an airplane (type)
e. At sea
f. Other

23. Were you (Circle One)
a. In the business section of a city?
b. In the residential section of a city?
c. In open countryside?
d. Near …

Page 5

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 when you first saw it. Place a "B" on the compass where you last saw the object.

![img-0.jpeg](img-0.jpeg)

![img-1.jpeg](img-1.jpeg)

28. 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…

Page 6

30. Have you ever seen this, or a similar object before. If so give date or dates and location.

31. 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 object too? (Circle One) ☐ Yes ☐ No
31.2 Please list their names and addresses:

32. Please give the following information about yourself.

|  NAME | Last Name | First Name | Middle Name  |
| --- | --- | --- | --- |
|  ADDRESS | Street | City | Zone  |
|  Ra Course | State | 54601 | Thiocerum  |
|  TELEPHONE NUMBER | AGE | SEX | female  |

Indicate any additional i…