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HEARNAP — Part 16
Page 233
233 / 934
4-21 (Rev. 2-11-65) fa FER a a
Type of Moll Date of Mail
| Rep
(_} Inco@ing letter
o Outgoing letter
((] Memorandum
(O Airtel
(7) Teletype
{_} Enclosure (describe)
° Bsc Work Sheet ,
2 ‘Personnel Security Questionnai re £PSQ).
~~
(CJ Loyalty Form
(CD Other (describe)
eat
Removed for Removed by Date of Removal
I~ we
Reason for Removai "
(0) For copying (If for another agency, list agency and date of request.)
[J To send to
oOo To attach to --
(_) For office use
([) For change to
[J Other (Specify) \_.
eit Lake SEN sae Sen adhere Re
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