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HEARNAP — Part 4
Page 218
218 / 672
PMI TS ee ee ye aa a°e™
4-21 (Rev, 2-31-65) ke
INSTRUCTIONS: This form is to be removed from file by a Filing Unit cmployee only upon the ratum of the item.
Subject 7
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Type of Mol ; Dote of Mail
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=) Incoming letter
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C] Teletype _ can _*
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(C} Enclosure (describe)
(()-Laberetery Work Sheet, .- - a - . oe
{CO Personne! Security Questionnaire (PSQ) —__ — a
oO Loyalty Form . :
oO Other (deacribe)
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Reoson for Removal ’ we
C) For copying (If for another agency, list agency and date of requeat.)
(CO To eend to
Cy} To‘attach to: ~~ -
{_) For office use
([) For change to another file
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