Form 6001 

 POST OFFICE DEPARTMENT 



j§ THIRD ASSISTANT POSTMASTER GENERAL 

 Q DIVISION OF MONEY ORDERS 



No. 



U DIVISION OF MONET OKUtKS, ^^ „ f ,„,,,„, 0fflM 



O 



B FEE 



O 

 w 



2 The Postmaster H 



will insert W 



I 



CL. 



S here W i 



°P the office drawn on, when the office * 



I named by the remitter does not trans- g 



mJ act money-order business. B 



5 — : -3 



j^J Spaces above this line are (or the Postmaster's record, to be filled in by him • 



- ■ n 



| Application for Domestic Money Order | 



O Spaces below to be filled in by purchaser, or, if necessary, (D 



5 by another person for him ^ 



° .Amount — 2 



§ use figures, r»~ii„,~, rw.+ CT » 



OT do not spell Dollars Cents 5 



6 > 



5 Tp be 1 p3 



Cm paid to/ (Name of person or firm for whom order is intended) 



O Whose"]" " " £ 



address \ f 



>? is) Street v 



S Olty ] -0 



o and 1- » 



State 



1 » 



J2 Sent by 



££ (Name of sender) ?! 



fe _„„ Street % 



2 City 1 «4 



and > 

 © state J , 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) oi«— 8391 



