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“Serial Remevol Charge Out Font »~ — An 4-21) {Rew. 2-Et-65)} INSTRUCTIONS: This | form is to be removed: from file by a Filing Unit employee only upen the return of the Item. Subject ; av rewerey Type of Mati | Report oO Incoming letter (C] Outgoing letter (7) Memorandum 3 Airtel ° ) Teletype tn A ([) Enclosure tdeacribe) oie - 4 c=? Ase Work Sheet re i im Personnel Security Questionnaire (PSQ) ([) Loyalty Form , (CO Other (deacribe)- pe eee Removed by : Date of Removal 3483 1-G: 7G | Reason for Removal . {7 For copying (If for another agéncy, list agency and date of request.) CC) To send to CJ To attach to () For office use (CO For change to another file £[] Other (Specify) ~ - C: Lh reve Dee iL Complete File and Saricl Number ) ~ / 22 O oOo ~ y ~ & ; . hd > ~ eos wen eee -. oy +p ea eM ee Pr - ——_ a ee mo ee