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Serie! Removal Charge Out ; “sy %- kN 4-21 (Rev. 2-11-65) * $ INSTRUCTIONS: This form is to be removed from file by a Filing Unit employce only upon the return of the item Subject we ft Type of Mai! Date of Moti — ([} Report {) Incoming jetter (Cj Memorandum Cl) Outgoing tetter ns [J Teletype | (1) Airtel | {_} Enclosure (describe | Laboratery Work ae —Z Le _ LEE? 4 : Lea AO ¥— . ([} Personnel Security Questionnaire (PSQ) | {_] Loyalty Form ([} Other (describe) Removéd for Removed by Date of Removal Mr. BPLLE JLL > a Reason for Removol (CO For copying (If for another agency, list agency and date of request.) (7 To send to (-) To attach to {[} For office use ((] For change to another file | Other (Specify)