Form No. 6001 



^oat (3f^t^ B^partm^nt HO. 



THIRD ASSISTANT POSTMASTER GENERAL 

 DIVISION OF MONEY ORDERS 



The Postmaster 

 will insert 



Stamp of Issuing Office 



here _ 



the office drawn on, when the office named by the 



remittor in the body of this application i^ not a Money Order Office. 



Spaces aboTe this line are for the Postmaster's record, to be filled in by hit 



Application for Domestic Money Ordei 



Spaces below to be filled in by purchaser, or. If necessary, 

 by anotber person for htm 



Amount 



,_ Dollars Cents 



l^eTot } E- W BQLQ J ANO & CO, 



(Name of peraon or firm for whom order is intanded} 



Whose 

 Address 



sose I 



Hno 1Q05L..B.-.ST.JN...W.. 



-Street 



Post } WASHINGTON, 



Office 



State -D,C^- 



Sent by 



(Name of Sender) 



Address! 

 of [ 

 sender J No Street 



PFRCHASEB aiUST SEND ORDER AXD COUPON TO PAYEE 



C6— 71*4 



