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Serial Removol Charge Out . - 4-21 (Rev. 2-11-65) () ( C) C) . “ * “~ — INSTRUCTIONS: This form ts to be removed from file by a Filing Unit employee onty upon the return of the item Type of Mail Date of Mail [J Report [_) Incoming letter () Outgoing letter (C) Memorandum CO Arte! ) Teletype [ Enclosure {describe} Personnel Security Questionnaire (PSQ) _ CO Leyalty Form (_} Other (deacribe) Rebséin for Removal (J For copying (If for another agency, liet agency and date of request.) (C) To send te CO To attach to (CD For office uae (2 For change to another file — ~ £5200 - /TH/ Complete File and Serial Number