Form No. 6001 



POST OFFICE DEPARTMENT 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 is in Alaska, and d oes not transact money order business. 



Spaces above this line are for the Posiroaster'3 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 



tn». J F. W. BOLGiANO & CO. 



Order of/ 



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



Whose" 



Whose 1 



"H - 4 " N. Y. AVE. N.E . _ 

 } 



State 



WASHINGTON, 

 office) p. C. — 



Sent by 



(Name of Bender) 



No. Street 



and \ 



State) 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 

 (FOR FEES SEE OTHER SIDE) c5— 7155 



