Form 6001 



POST OFFICE DEPARTMENT 



THIRD ASSISTANT POSTMASTER GENERAl, 



division of money orders Stamp cf Issuing Offlca 



fee; 



The Postmaster 

 will insert 



here „_ 



the office drawn on, when the office 

 named by the remitter does not trans- 

 act money-order business 



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



Application for Domestic looey Order 



Spaces below to bo filled in by purchaser, or, if necessary* 

 by another person for him 



Amount — 



F dq HoiF spell - Dollars Cents 



_ , , Peter Henderson & Co. 



To be 1 



paid to J (Name of persoa or firm for whom order is intend? a j 



address! 35 Cortlandt St. 



is! Street 



Sri New York 7, N. Y. 



State! „ 



Sent by . 



.} 



(Name of sender) 



Streei 



City 1 



and 



State) 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) o7— 10— 8391-2 



