Dollars Cents 



Stamp of Issuing dfflca 



p p 

 ■t; M 



Si 



(Form No 6001 r 



the Postmaster 

 will Insert 



-.ne office drawn on, when the office named by the remitter In the body 

 jf this application is not a Money Order Off ce. 



Spaces above this line are for the Postmaster's lecord, to be filled ia by him. 



f £ Application for Domestic Money Order 



""p Spaces below to be filled in by purcliaser. or. If necessary 



bv another person ft r him 



cs 



Amount 



~o 



C 



ro o 



_ Dollars Cents 



'orLr'o. \ WALTER P. STOKES, 



I Name of person or firn* f o r 



I onler is iDteodeii i 



Whose ) 

 Address - 

 Is 1 No. 



Post I 



Office i 



219 Market Street, 



PHILADELPHIA, 



State Pennsylvania 



Stree* 



£>. 



a a 

 a> o 



a 



Sent by. 



( Same uT Seudc 



Address.) 

 of V . 



•ender J No Street 



PURCHASER MUST SEND ORDER ' 'N BLUE PAPER) TO PAYEE 



