Form No. 6001 



POST OFFICE DEPARTMENT NO. 



THIRD ASSISTANT POSTMASTER GENERAL Stamp ol Issuing Cilice 



DIVISION OF MONEY ORDERS 



The Postmaster 

 will insert 



here 



the office drawn on, when the office named by ( 



the remitter in the body of this application is not a Money Order Office. 



Spaces above this line are for the Postmaster's record, to ba 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 



, F.W.BOLGL 



Order i 



Payto x F.W.BOLGIANO & CO 



■ of/ 



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



22&L.1 607 E STREET N.W. 

 is j no WASHINGTON £,reet 



Post \ 



e/ 



Office/ 



D.C. 



State 



Sent by 



(Name of Bender) 



Address] 

 of \ 

 sender I No Street 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



c5— 7155 



