PCSTAGE 
is 
ea | New York N. ¥- 3 
S State 
bat 
Z, 
a“ 
=f Form 6001 
‘ D Sa POST OFFICE DEPARTMENT No 
oD) oe) THIRD ASSISTANT POSTMASTER GENERAL Gee 
(Se) Lod Pl 5 DIVISION OF MONEY ORDERS Stamp of Issuing Offles rl 
Yo (=) 
O @D 3 
z 5 FEE a 
ad 
J =o Vv S Tho Postmaster a 
will insort tA 
Sq Z < =) 
2. & 5 here ------.----~-----=-=---- Seer , 
ra) fA the office drawn on, when the office i) 
| © Seat | named by the remitter does not trans- Be 
| ~] act money-order business. 
) o) = <4 | 
eS) Ss Spaces abore this line are for the Postmaster’s record, to be filled in by him 2 
la Dee: Se 
a) © Application for Domestic il Order? 
\ ° Bf 
in = Application for Domestic Money Ur er 
(ea (as) rs) Spaces below to be filled in by purchaser, or, if meceseary, @& 
' & by another person for him K 
Z, z Amount— g 
USE FIGURES, 
fled a DO NOT SPELL ---------=- Dollars --------- Cents & 
fd 
an, E sn Peter Henderson & Co... 
A paid to (Name of person or frm Tor whom ordor is intended) 
fas eg = 
Son ae Caetlande St... faa 
Cr) address | 35 Cortlandt St. re 
ae x e 
Qs 
A) a pe eee oie © 
ee eerie! (Name of serder) PF 
E& @ 
IESE oe eee none rane een ane prea Sema Street 
8 city q 
and 
8 PSE Ch (ea a arian ep a 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) o16—8801 
ot ae 
