Form 6001 

 ~ POST OFFICE DEPARTMENT 



§ THIRD ASSISTANT POSTMASTER GENERAL 



2 DIVISION OF MONEY ORDERS Stamp of IbuIdj Office Q 



| FEE w 



S The Postmaster M 



* will Insert 



I 



ft, 



fc here 



gj the office drawn on, when the office 9 



I named by the remitter does not trans- 8 



I act money-order business. 



S Spaces above this line are (cr Postmaster's record, to be rilled in by him 



I Application for Domestic Money Order g 



^T Spaces below to be filled in by purchaser, or, if necessary, 3 

 S by another parson for him <^ 



g Amount — § 



BSE FIGURES, Tv 11 /~1 j. » 



w do not spell .Dollars <L/ents i 



a Toboi I*«^t*?i- Henderson & Co. > 



r"J paid toj (Name of person or firm for whom order is intended) ^ 



{£ & 



© Whose ] ..,»£• 



. address \ 33 Corllanclt St. 5 



2 is ) 8treet 



|ar!d y l New York, N. V. 1 



Jg State I g_ 



ry? _ "^* 



S Sent by Q^ 



P* (Name of sender) © 



H •? 



O Street ;S 



Z City 8 



e, and "< 



q State J 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) 0I6— 8391 



