Form No. 6001 



POST OFFICE DEPARTMENT W 



THIRD ASSISTANT POSTMASTER GENERAL Stamp of Issuing CSea 

 DIVISION OF MONEY ORDERS 



The Postmaster 

 ■vriil insert 



1 here 



the office drawn on, when the oiBce named by 



the remit ter is in Alaska, and does not tr ansact money order business. 



Spaces above this line are for She Poslmaster's record, to be filled in by him 



.Application for Domestic Moissy Order 



Sfsaces below to be filled in by pun-chaser, or, if necessary, 

 by another peFson for him 



'Amount 



Dollars Cents 



I Pay to I Peter Henderson & Co. 



[iiOrder ofj .— 



(Namo of person or firm for whom order ia intended) 



IX'Ll 35 Cortlandt 



Is jNo Street 



a} New Yprk.... 



State N...Y. 



Sent by 



(Namo of sender) 



No. : Street 



City] 

 and > 

 State) 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



CFOR FEES SEE OTHER SIDE) tS— 7155 



