[104-10182-10004.pdf — page 78]
UNCLASSIFIEDINTERNALONLYCONFIDENTIAL-SECRET# ROUTING AND RECORD SHEETSUBJECT: (Optional)Examination of Agent in Safehouse September 3, 1959FROM:AC/OD/MS 2714 I Building (3348)DATE9 September 1959TO: (Officer designation, room number, and building)|     | DATE RECEIVED                         | DATE FORWARDED | OFFICER'S INITIALS | COMMENTS (Number each comment to show from whom to whom. Draw a line across column after each comment) || --- | ------------------------------------- | -------------- | ------------------ | ------------------------------------------------------------------------------------------------------ || 1.  | C/SR/DOB Attention: Mr. William Romer |                | Hill               |                                                                                                        || 2.  |                                       |                |                    |                                                                                                        || 3.  |                                       |                |                    |                                                                                                        || 4.  |                                       |                |                    |                                                                                                        || 5.  |                                       |                |                    |                                                                                                        || 6.  |                                       |                |                    |                                                                                                        || 7.  |                                       |                |                    |                                                                                                        || 8.  |                                       |                |                    |                                                                                                        || 9.  |                                       |                |                    |                                                                                                        || 10. |                                       |                |                    |                                                                                                        || 11. |                                       |                |                    |                                                                                                        || 12. |                                       |                |                    |                                                                                                        || 13. |                                       |                |                    |                                                                                                        || 14. |                                       |                |                    |                                                                                                        || 15. |                                       |                |                    |                                                                                                        |FORM1 DEC 36610USE PREVIOUSEDITIONSSECRETCONFIDENTIALINTERNALUSE ONLYUNCLASSIFIED