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4-21 (Rev, 2-11-65) INSTRUCTIONS: forn Seria} Removal Charge Out Subject ; ; . _ ot . so } - Date of Mail . (—) Incoming letter (} Outgoing letter (_] Memorandum {_) Airtel ((} Teletype Co Enclosure {describe} Enabornters-Work Sheet (_] Peraonnel Security Questionnaire (PSQ) (—j Loyalty Form , C3 Other (describe) Removed for . Removed by , Date of Removal Reoson for Removal (2 For copying ‘If for another agency, list agency and date of requeel.) (C) To send to (C) To attach to (7) For office use (EC For change Je — _—— ae a Capone Se CT ge” . Complete File and Seric! Number =~ A 3S eet 7 > . ee