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Be ee ee re nes i Serial Removal Chorge Out @ tom 4-21 (Rev. 2-11-65} - INSTRUCTIONS: This form is to be removed from file by a Filing Unit enplovee only upon the return of the item. Subject } Ntaryre, Type of Mail ~ Date of Mail [2 Report ([} Incoming letter [7] Outgoing letter {(_) Memorandum [> Airtel CL] Teletype (7 Enclosure (describe) | D . ([} Laboratory Work Sheet 9 — Ln ~ } G {_] Personne) Security Questionnaire (PSQ) (() Loyalty Form (C) Other (describe) Removed for Removed by Date of Removal GA Mr. L_] Mrs. {_j Miss Dy . . {_j Room 1 > {S / G 7¢ Reoson for Removol [_) For copying (If for another agency, list agency and date of request.) (_) To send to (_) To attech to (_} For office use {((} For change to another file {[} Other (Specify) C Sree —_> Compiete File ond Serial Number. = S. OG