Form No. 6001 
POST OFFICE DEPARTMENT iin 
THIRD ASSISTANT POSTMASTER GENERAL Stamp of issuing Offics 
DIVISION OF MONEY ORDERS 
The Postmaster 
wili insert 
the office drawn on, when the office named by 
the remitter is in Alaska, and does not transact money order business, 
Spaces above this line are for the Postmaster’s record, to be filled in by him 
Application for Domestic Money Order 
Spaces below to be filled in by purchaser, or, if necessary, 
by another person for him 
Amount 
(Name of gender) 
pie tA EI oe Se aS LT, 8 Eh Street 
City ae 
and 
State 
PURCHASER MUST SEND CRDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) e5—7155 
