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Serial Removal Charge Ou! - He2d Paice. Te -iy @ INSTRUCTIONS: This form is to be removed from file by a Filing Unit e:nplovee only upon the return of the item, Subject $aA Type of Moi} i , Va Report. 3 om $ > Dete of -Moil —- (—} Inceming letter {7} Ovigoing letter (-) Memorandum — (7) Airtel [_) Teletype (7 Enclosure (deseribe) 3 , a ot et, Laboratory Work Sheet a ae pre = . (Jj Personnel Security Questionnaire (PSQ) ([) Loyalty Forin 7} Other (describe? Removed for Removed by Mr. “| Mrs. 1 Miss C.. EF) Room ee Ye ed Reasan for Removal (CJ For copying (f for another agency, tist agency and date of request.) Aaa Date of Removal 4 fo OF (_] Te aenil lar (7) To nitnch to (7 For office use (2) Por chase bo enother file Gf oe (Specify) ns / te { : Complete File ond Serial Number 4. ape a oe ee. ee ewe wg tt