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Seriat Removal Chorge Our . ~ 4-7} {hie ve TH-1S-65} @ ) INSTRUCTIONS: This form is to be removed from {ile by a Filing Unit e-aployee anly upon the return of the item. Zé Octe of Mail Type of Mail f_} Report # ‘3 {_} Incoming Jetier (77 Oulgoing letter (3 Memorandum (=) Airtel (1 Teletype (] Encinsure (describe? — . TL a “0 - Dit we a A ’ a 4. a~ a aa Lashoralery Work Sheet. pei ae cach : Lore FOE {[} Peraonncs Security Queationnaire (PS&Q) [1] Loyalty Form eee {7} Other (dercribe? ee Removed for Removed by Oate of Removal Mr. — Kirs. 4 Miss ot — a a Reoson for Removal (7) For copying (If for another agency, list agency and date of requeat.) () Teo send to ——-—-_- (CQ To wituch to — (7) Fer offire ure a [7] For ehange to another file qf Other (Specify! -—-—__._— a ee er ee et ef _. SDT Cal ' Complete File ond Serial Number