(Form No. 6001) 



PflHt ©ffir* Srpartment NO. 



THIRD ASSISTANT POSTMASTER GENERAL Stamp of Issuing Office 



DIVISION OF MONEY ORDERS 



The Postmaster 

 will Insert 



here 



the office drawn on. when the office named by 

 the remitter in the body of this application is not a Money Order Office. 



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 



_ Dollars Cents 



5H* of } FRANC I S C- ST OKES & CO., 



(Name of person or firm for whom order ia intended) 



Whose ) 



Ad l ress j no 235 East Washington Square, stre 



SSfce } PHILADELPHIA, 



State PENNSYLVANIA. 



Sent by 



(Name of Sender) 



Address 

 ol 



sender j No. Street 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



