Form 6001 



POST OFFICE DEPARTMENT NO. 



THIRD ASSISTANT POSTMASTER GENERAL s; arap of | ssuing 0f(jce 



division of money orders 



FEE 



The Postmaster 

 will insert 



here 



the office drawn on, when the office named 

 by the remitter is in Alaska, and does not 

 transact money-order business. 



Spaces above t his line are for 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 Kim 



Amount — 



USE FIGURES, \ Tlnllnrc. CVntQ 



do not spell / .uoii&rs i_,ems 



Whose 1 



addr f ( 35 Cortlandt St. str6 et 



City 

 and 

 State 



-New-York N,Y, 



Sent by . 



(Name of sender) 



Street 



City] 

 and > 

 State) 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) "=5— 7155 



