Form 6001 



POST OFFICE DEPARTMENT Mn 



THIRD ASSISTANT POSTMASTER GENERAL ■«*■ 



division of money orders Stamp of Issuing Office 



FEE 



The Postmaster 

 will insert 



here 



the office drawn on, when the office 

 named by the remitter does not trans- 

 act money-order business 



Spaces above this line are (or 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 — 



DSE F W!pell — Dollars _. Cents 



To be | 



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



Whose] 

 address > 



is| Street 



2TJ 



State 



Sent by 



(Name of sender) 



Street 



City ) 

 and } 

 State] 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) cie-ssoi-tf 



