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Seriat Removal Charge Out 4-21 (Rev. 2-14-65) f -' 6 van van INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the retum of the item Type of Mail . Date of Mail £_] Report : [-] Incoming letter (_) Outgoing letter [-} Memorandum CO Airtel (_) Teletype TC) Enclosure (describe) {_} Laboratory Work Sheet (7) Peraonnel Security Questionnaire (PSQ) (Cj Loyalty Form ((} Other (describe) Removed for Removed by Onte of Removal 1-6-7¢ Reason for Removol ([) For copying (If for another agency, list agency and date of request.) | To send to ([] To attach to CC) For office use {(} For change to another file {—) Other (Specify)