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Serial Removal Charge Out A . oy 4-21 {Rev. 2+1 1-65} th has co: : af INSTRUCTIONS: This form is 40 be removed from file by a Filing Unit employee only upon the retum of the Item. Subject . “He eye Type of Mail § Date of Mail (3 Report j L-} Incoming tetter (—} Outgoing letter ([] Memorandum (J Airtei (C] Teletype {_j Enclosure (describe} {£7 Laboratory Work Sheet {_] Personnel Security Questionnaire {PSQ? (_} Loyalty Form (CJ Other (describe? Date of Removal Reuson for Removal {_] For copying (Hf for another agency, list agency and date of request.) {c] To send to £7 To attach to {_} For office use (_} For change to another file (—} Other (Specify) Complete File ond Seriof Number “{- \ 5 a Q DB ~~ ol G 3]