Form No. 6001 



post W^tt lepartm^nt 



THIRD ASSISTANT POSTMASTER GENERAL 

 DIVISION OP MONEY ORDERS 



The Postmaster 

 will insert 



i liere 



the office drawn on, when the office named by the 



80. 



Stamp of Issuing Office 



fe £ remittor in the body of this application is not a Money Order Office. 



2 cS Spaces above (his line are for the Postmaster's record, to be Siled in by hiia 



s ^ 



? I Application for Domestic Moeey Order 



o 2 Spaces below to be filled la by purchaser, or. If necessary, 



^•g by anotber person tor Imu 



f £ Amoimt 



Dollars Cents 



WM. HENRY MAULE, INC., 



(Naiae of person or firm for Trhom order is intended) 





ray to \ 

 Order of / . 



^ ^ Whose I 

 ^ i Address} 

 ; c is J No 



-T. Post \ 



j^ Office/ 



.Str6et 



r,c Sent by - 



PHILADELPHIA, 

 State .^^.li^-PiylYg!^!^- 



(Nome of 8«ader) 



Address) 

 of [ 

 sender ) No Street 



PXJKCHASER MUST SEDTO OEDEB AND COUPON TO PAYEE 



cfi— 71J8 



