Stamp of Issuing Oifice 



Form No. 6001 



post (§Mt$ ^^purtmsnt 



THiRD ASSISTANT POSTMASTER GENERAL 

 DIVISION OP MONEY ORDERS 



The Postmaster 

 trill insert 



- -iere 



gthe ciBce drawn on, when the office named by the 



, -Toinitter in the body of this application is not a Money Order Office. 



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



lAppSicatiofl for Domestic Moeey Order 



: 5 Spaces below to be filled In by pufchaser, or, U necessary, 



^ by another person for him 



' iAjnoimt 



I i Dollars Cents 



''Ipayto X V/M. HENRY MAULE, INC., 



^"oOrder ot / . 



S 'r (Name of peraon. or firm for whom order is intended) 



It 



o. ^jJWtose I 

 g- ^Address}- 

 y. S is J No Street 



^Ipost I PHILADELPHIA, 



^ Joffice / 



^j State l!!l^^y!^n!^: 



= 5Sentby 



C ^ (Name of Sender) 



■n gAddressl 



^ sender ) No Street 



^ PURCHASES. MUST SEND ORDER AND COUPON TO PAYEE 



05— 



