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Serial Ramoval Chorge Our ~ : : ; _ : 4-21 (Rev. TPR 65) — 7’ ‘ om INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the return of the item. Subject : Type of Moll C) Incoming letter [7] Outgoing letter (—) Memorandum (Airtel (L} Teletype - {(C] Encloaure (describe) (7) Laboratory Work Sheet . 6-20 dl ‘ (_) Personne! Security Questionnaire (PSQ) £.) Loyalty Form Co] Other fdescribe) Removed by ~ Date of Remevat 343 (6-70 Reason for Removai Cj For copying (If for another agency, list agency and date of request.) (TJ To sendto - CO To attach to CC) For office use - ([) For change to another file (5) Other (Specify) Cot - ad Ow st AW Orth 8 Complete Fite and Serial Number “fj - 5 A 00 -