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twee i t Seriat Removal Chorge Out AEX ay €> ar 4-21 (Rev. 2-11-65) : 2 INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the return of the item. Type of Maii Oste of Mail (3 Rep nn [7] Incoming letter nn _—___-—-~ a {7} Outgoing feiter nen £2 Memorandur I 7} Teletype ee ne tN Work Sheet, oO Peraonne) Security Questionnaire (Ps) ee _ . - CO Loyalty Form . 7 CT tee am) Other (describe) a oo Ramoved for , Removed by Octe of Removal I~bo Te Reason for Removol {([} For copying (If for another agency, liet agency and date of request.) {_j To send to {7} To attach to coos {_} For office use eon (Specify) - , : IK 2 we Complete File ond Serial Number mer \5 200 ° ONS