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TT eer li I A ane Foe et mn le eer Nn a al le hk try lint: melt ee 8 nt ye hada dee mela A Ft kava toe Serial Removal Chorge Out ; . . 4021 (Hew. 2-1t-65} c™ ne any - INSTRUCTIONS: . This farm is to be removed from file by a Filing Unit employee only upon the return of the item. Subject . . | Hi ' . Type of Moil 4 Date of Mail ([] Report (C) Incoming letter (} Outgoing letter (_) Memorandum ) Airtel (_} Teletype I! CQ Enclosure (describe) . Ate nt (Cf Laboratory Work Sheet ({) Personne} Security Questionnaire (PSQ) (() Loyalty Form (1) Other (describe) Removed for Removed by Dote of Removal (ef Mr. ‘ cise Wn Baal 3Y3 1-O-°7G Reoson for Removal [_) For copying (If for another agency, list agency and date of request.) {_] To send to (_) To attach to (_} For office use LD For change to another file Complete File and Serial Number 7 a | or < O ~ 3 ) i. S