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Seriat Removal Charge Out iv ) 4-21 (Rev. 2-11-55) a erH ah SB x INSTRUCTIONS: employee only upon the return of the item. Type of Mai} Dote of Mail (_) Report (7) Incoming letter {_} Outgoing letter ——— (_) Memorandum — ee [2 Airtel ee ([} Teletype ee (7) Enclosure (describe) (__} Personnel Security Questionnaire (PSQ) £_) Loyalty Form {"} Other (describe) + et Removed for Date of Removal Mr, ia Room Reason for Removal [7 For copying (If for another agency, list agency and date of request.) . j Removed, by (CJ To send t& (_) To attach to (LJ For office use 77> Complete File and Sorlal Number ~ Sogo — Zo