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Serial Removal Chorge Out - ®e@ . @ 4-21 (Rew. 2-11-65) aor INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the return of the Item. Subject (} . ha Type of Mail Dote of Mail C) Report [ Incoming letter {_} Outgoing letter {() Memorandum CD Airtel {_] Teletype [] Encloaure (deacribe) (—) Personnel Security Questionnaire (PSQ) ([) Loyalty Form CC Other (describe) Removed by Dote of Removel J-€ Reason for Removal (7) For copying (If for another agency, list agency and date of request.) [> To send to (CO To attach to TC For office use on nn, (3 For change to another file es 7 Power (Specify) Complete Fite ond Seriol Number -/. CEL) O- J3 DC