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HEARNAP — Part 10
Page 121
121 / 454
Serial Removal Chorge Out
422) lite, 2b 1-65) haa) fF =
INSTRUCTIONS: This form is to be removed from file by a Filing Lint employee only upon the return of the item,
[Subject
Al C hirli a
!
Type of Mail
oO Report
Dote-of-Mail
Cc) Incoming jetter
om) Outgaing Setter eT
a) Memorandum a
() Airtet | me
[9 Teletype nn
Cl Enclosure (deecribe? —————_____~_—_--—_________-____________-_—_—_-
Lafowt
OA batons ork Sheet
{_) Personne} Security Questionnaire (PSQ}
(C] Loyalty Form
{_] Other (describe)
Removed by — Date of Remaval
Reason for Removal
. [) Fer copying (If for another agency, list agency and date of request.} .
-() To send to a
{J To attach to
- TC) For office use
C] For change to another file
; A orrer (Specify)
Complete File and Seria! Number
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