Here Write Plainly Name and AddreM 



Name 



R.D. or Street 



Postoffice 



State 



Philadelphia, 



P.O. Box 1296. 



Peiina.,'U.S.A, 



stamp 0? issuin!! Oaiee 



Form No. 6001 



POST OFFSCE DEPARTMENT 



THIRD ASSISTANT POSTMASTER GENERAL 

 « DSVISION OF MONEY ORDERS 



'^ ^The Postmaster 



g gfeere 



g '^tbe office drawn on, when the office named by 



g Slhe remitter in the body of this application is not a Money Order Office. 



^ c Spaces above this line are {or the Postmaftor's record, £o be filled in hy Siim 



jApplication f ©r Domestic Meisey Order 



'^ ►" Spaces below to be i513ed ir* by purchaser, or, if mecessary, 

 " "O by anothesT person for blm 



i gAmount 



^1 Dollars 



r|SL'°of} -WM...HENRY.MALJLE.CO.^ 



tr ^ (Name of i>ersoQ or firm for whom order ia intended) 



5 g Whose 1 

 "Address}- 



a-S 



J No Street 



%^ltoe} PHLLADE^PHIA.,.. 



; Office) 



3-0 



5 >> 



g c Sent by - 



State fe|?_^sxlvama._ 



(Naxno of sender) 



g Address] 

 of \ 

 sender J No Street 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



c5— 716S 



