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HEARNAP — Part 16
Page 196
196 / 934
leat
1
Sericl Rempvol Charge Out ca *
4-21 (Rev. 2-11-65) - _ ry . Br FP
G
INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the return of the item
|
Type of Mai) Date of Mail
() Re
[7] Incoming letter
(_) Outgoing letter
([) Memorandurr
CO Airtel
aa] Teletype , an - —_—
(7) Enclosure (describe) —___
\se
Py bebaratoey Work Sheet . ... -
oOo Personnel Security Questionnaire (PSQ}
aa] Loyalty Form
(C) Other (describe)
Removed for Removed by Date of Removol
Mrs.
Missa
Room
Rea
Reason for Removal _
(7) For copying Uf for another agency, list agency and date of request.)
(CI To send to
(7) To attach to
(OO For office uee
(0 For change to ang
corner (Specify) —
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f
. tte
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Complete File and Serio! Number
5s ME NES GOREN?
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