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Serial Removal Cherge Out JP ‘ : 4.2} {Rev, 2 65) ie 0 . Ah INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the return of the Item. Subject OOS FZ OH Type of Mall U : Date of Matt "#5 Report : (C1 Incoming feteal (]} Outgoing letter £7} Memorandum (2) Teletype {~] Airtel et (I Enclosure {describe} Latent (orLaboratory Work Sheet - Y - {[} Personnel Security Queationnaire (PSQ) {7] Loyalty Ferm (_} Other (describe? Removed tor Removed by Date of Remora! ‘(3 Mre. Cc . u ; a Sue Bode | 343 j-G Tl Reason for Removal ([] For copying (if for another agency, list agency and date of request.} C7] To send to (77 To attach te (7) For office ure [7} For change to another file ~ ([} Other (Specify) _ we -_ q Complete File and Serial Number ~ 5 pe 00 ~ J