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Serial Removol Charge Out . 421 (Rew. 2u2)-65) iim os - &>. e@ ® INSTRUCTIONS: ‘This form is to be removed from file by a Filing Unit employee only upon the return of the item. (__] Report ((] Incoming letter (_) Outgoing letter CQ Memorandum (C) Airtel C"] Teletype (C) Enclosure (describe) fork Sheet Ooh A ME \ / fF ~ 7 {[} Personnel Security Questionnaire (PSQ) —————_¥ nnn ([) Loyalty Form (C] Other (describe) - Date of Removai 2. No & etable | 7/-G-76 CO Roo Ia & — ao Reoson for Removal (C) For copying {If for another agency, list agency and date of request.) C] To send to CO To attach to (C) For office use (] For change to anothér fhie am (Specify) Complete File and Serial Number ~ IS Q O0O0- 3 G