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Surreptitious Entries Black Bag Jobs — Part 23
Page 37
37 / 87
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TECHNICAL SuRVaILL ANCE ~ GEN CRACK (i
MEmMo CANTO :Y
VRE TAP LY Ve
Serial Removel Charge Our
4-21 (Rev. 2-Lee5) ® Pp .
_- »?
INSTRUCTIONS: This form is to be removed from file by a Filing Unit employee only upon the return of the item.
anneal na
T
(_] Incoming fetter
(J Outgoing letter ere
Di semen 7S £.5, Micer Efe f/72
(_] Airtel
71 Teletype
fT] Enclosure {describe}
Cj Laborntery Werk Shoct
(_] Personnel Security Questionnaire (PSQ)
(7) Loyalty Form
() Other (describe)
Removed for Removed by
Mr. Hons Svéve
Mrs. °
{__] Miss
he Reom TFled 4
Reason for Removal
Dote of Removal
Cavin RIGHTS
- f f
S fF fe I77?
UPckwy AVPREVIG MA, Pe NAC
ni 7
CC] Fer copying (f for another agency, list agency and date of request.)
fj To send to
(-] To attach to
(_] For office use
{_] For change to another file
)
OH] Other (Specify) Foe REVIEW ON Covie ty
RETOUR NE __
Complete File and Serial Number
a bb b -
—
ATE
oe.
¢ e
Reeuy th O At GinaAt. LO
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