(Form >o. flOOl) 



iPoHt (9&ct Srparlmrul NO. 



r^lim ASSISTANT POSTMASTER GENERAL ttlwt »l ituit OWc* 



E. ? DIVISION or MONET ORDERS 



« a: L 



LAMS CCNTS 



5 3e 



•A^ I ^ not a Money Order Office. 



/^g)lication for Domestic Money Order 



b«loa to be filled In br purchaser, or. If necettart. 

 £ ; bi another person for him 



Mmouut 



"H,^ .. Dollars Cents 



i3".. : - F. W, BOLGJAI»LA.CQ^ 



'• u ) No. 



1009 B- Street N. W. _. 



^31} 



Washington. 





R.te D. C. 





z -^ 



(ita^.r ted^, 



''f^tMeT )' No. 



.street 



^ibchaser :«iust send oaoer and coupon to P^VFP 



