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HEARNAP — Part 21
Page 6
6 / 1025
Serial R te a O
nein meee ae “cA ca
C) Report
Type of Mail i ! Date of Mail
(LD Incoming letter
(] Outgoing letter
CC) Memorandum
0 Airtel
(-) Teletype
om)
Xv
& Aatunsh Sheet | AP, Le A 8 5
{_] Personnel Security Questionnaire (PSQ)
(C] Loyalty Form
[) Other (describe)
“Se for Date of Removal
} Eat.
5 Misa
| [J] Room
Reasan for Removal
(0) For copying (If for another agency, list agency and date of request.)
[J To send to
(-) Te attach to
CC For office use ea
(7) For change to ano file
Dorner (Specify) ~
Comptete File and Serial Number = [5 O- BABI
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