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Seriad Removal Chorge Out r . 4-21 {Rew. 2-11-65) r-- g® r= e@ INSTRUCTIONS: ‘Thaeetorm is to be removed from file by a Filing Unit employer only upon the return of the item. Subject 7 - ~~ fa - Y . Type of Moil § — - Date of Mol - (J Report : . ; ; a ‘(7 incoming letter (} Outgoing letter {0} Memorandum , (} Airtel (Lj Teletype © nn ‘ pee ([} Enclosure {deacribe) _. “ (} Personne! Security Questionnaire (PSQ) {7} Loyalty Form [—] Other tdeacribe} Removed by ; Cote of Removal Reason for Removal //e fre (7) For copying {If for another agency, \tat agency and date of requeat.} (CI To send to {-]} To attech to C1} For office use (C0 For change to another file — Complete File and Seric! Number