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Serial Removal Charge Out _ ot . ro rs 4-21 (Rev. 7-11-64) . ‘ ° INSTRUCTIONS: This form is to be removed from file by a Filing Unit employce only upon the return of the item. Type of Mail * [j Report (} Incoming letter oO Outgoing letter (Cj Memorandum () Airtel . Cl Teletype {_} Enclosure (describe) - —f Kt (aq Laboratory Work Sheet (_] Personne! Security Questionnaire (PSQ) ([] Loyalty Form C] Other {describe} Removed far. Removed by | r Date of Removal EjMs. -7 — B® wele . Fits —MOwete—_| 343 [-G-7¢ Reason for Removol () Fer copying {If for another agency, list agency and date of request.) {(} To send to ([) To attach to ([} For office use {_) For change t6 another file CC) Other (Specify) Loe th Se Aawe ee. a> Complete File ond Serial Number ~ [53 0 O ~ s X ‘S |