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HEARNAP — Part 14
Page 613
613 / 987
Serial Removal Charge Our : a —
re2D fiey. Zed 1-64) @ r :
INSTRUCTIONS: This form is ta he removed fram file bv a Filing Unit employee only upon the return of the item.
Date of Moll 3
eae —- rrr 4
Cj Incoming letter OO
CC} Ont going fetter —_
3} Memorandum
[[) Airtel
(() Teletype
(7) Enclosure (describe? a eee
aoe oa ‘
5 Iaeboratony Work Sheet
“. tet 1 ” . Sof yj?) 5 . re - wa
(_] Peraonne} Security Questionnaire {PSQ) ‘
(() Loyalty Form —__
([] Other (describe) eo
Removed for Removed by Date of Removal
Mr.
{""] Atrs.
Miss _-s —
Reason for Removol
(07) For copying Uf for another egency, list agency and date of request.? .
(C3 To send to
(ct To attach te ee
(C7) For officer use
(2) For change to another file .
ch Other (Specify) ~~ :
7 .
Pi adiedl
wi atins
ae - 2 —_— . 7
Complete File and Serial Number ° wo) petit ane <— rene
nl
Wan agi Fe hy
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