◆ SpookStack

$erla! Removal Charge Out a @ ; ® 4-21 {Rev. 2-11-65) (3 { : toy Type of Mall Date of Mail ([} Report ) Incoming letter — 7} Outgoing letter a [_} Memorandum a ) Airtet a (_) Teletype ne [2 Enclosure (describe) ——————____———_———— i [7 Personne! Security Queetionnaire (PSQ) (Cj Loyalty Form vs (L) Other (deecribe} Date of Removal LL Reoson for Removal [D For copying (If for another agency, list agency and date of request.) (I To send to ———— {(C) To attach to ([) For office use i a 2,7 9, Hoo (Bpecify) . i ee ee Complete File and Serial Number qt rere