Form No. 6001 



3 ?: Pnst ©ffir^ ^tpwcttmnt m. 



TyiRD ASSISTANT POSTMASTER GENERAL 

 ^ DIVISION OF MONEY ORDERS 



TIfe Postmaster 

 ■wfll insert 



Stamp of issuing Office 



7hete — 



.^thfe office dra^ni on, when the office named by the 



-~reHiittcr in the body of this applieation is not a Money Order Office. 



rSEices above this line are for the Postmaster's record, to be filled in by hln-. 



^application ior Domestic Money Ordev 



- ~ Spaces below to be filled in by purchaser, or, if necessaxy, 

 ■~ 7 by anotlier person lor him 



uAinount 



/^Pay to \ 



.=OWer of / 



(Name of person or fim» for ■whoni order is intended) 



1-;...- ...iaoa-B--Str-et--Lt-w. 



-Wiose I 



J^I'^^Ino -WaShU.g.tCIt^- Stree. 



:?Office} D^-C 



- ._ State 



dScntby 



(Name of Sender) 



::: sender ) No Street 



PUKCHASEB aiUST SEND ORDE& AND COUPON TO PAYEE 



C5 — 7155 



I No. 



