Form. No. 6001 



No. 



POST OFFICE DEPARTMENT 



THIRD ASSISTANT POSTMASTER GENERAL Slamp o> Issuing Offiea 



DIVISION OF MONEY ORDERS 



The Postmaster 

 will insert 



here — — - 



the office drawn on, when the oiflee named by - 



the remitter in the body of this application is not a Money Urder ottice 



Spaces aboTe IhU line are for the Postmaster's record, to be 611ed in by him 



Application for Domestic Money Order 



Spaces below to be 6lle<l in by purchaser, oti i( necessary. 



^pace 



Amount 



by another person for him 



Dollars Cents 



Whose I 



Address j^^ 1304 SpTiog QaPdeH Slg' 



Post \ 

 Office/. 



Pblladelpliia 



State P-enoa.- -.- 



Sent by_ 



(Name of sender) 



No. Street 



City) 

 and > 

 State) 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



