u Form No. eooi 



^ ^IRD ASSISTANT POSTMASTER GENERAL Stamp of issuing Offic e 

 DIVISION OF MONEY ORDERS 





-^^ hgre 



p t^e office drawn on, when the office named by the ,__ 



-" rgnittcr in the body of this appUcation is not a Money Order Office. ' 



^aces above this line are for the Postmaster's record, to be gHed in by hiir. 



2 Ipplication for Domestic Money Order 



5 ^ Spaces below to be fiUed in by ptircliaser, or, if necessary. 

 '^ '^ by anotber person for him 



I j^ount 



|5--- -F-"-Wv-©0lg!iffer^.-Co,,-- Cents 



r I&y to \ 

 -p C^der of / __ 



■■ Q <Nameof person or firm for whom order iTtatended)' 



l^j iooa-a-&tfi£et-K.-W.. 



>■ gi?n No -Washington^ street 



^(®ce} JX£^ 



^ Z State 



•- u 



^^ent by 



^ t>, (Name of Seader) 



^ V 



jAadress 

 ^ s^der 



^ ^of } 



JNo. 



. Street 



PURCHASER MUST SEND ORDEH AND COUPON TO PAYEE 



C5— 7155 



