Form No. 6001 



POST OFFICE DEPARTMENT nO 



THIRD ASSISTANT POSTMASTER GENERAL Stamp of Issuing Office 



DIVISION OF MONEY ORDERS 



The Postmaster 

 will insert 



here 



the oiSce drawn on. vrhen the office named by 



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



Spaces above this line are far the Postmaster's record, to be filled in by him 



Application for Domestic Money Order 



Spaces beiov/ to be filled in by purchaser, or, if necesseu-y, 

 by another person for him 



Amount 



Dollars Cents 



S?5i°of}.!^:W.BOLGIANQ a C^^^ 





(Mame of persoa cr firm for Vvhom order is intended) 



Whose 

 Address 

 Is J No 



Pose \ 

 Office/ 



607...E.STREET_N,.W,,„,,, 



WASHINGTON, 



State Q.C 



Sent by 





No 



(Mame of sender) 



States .- _ .. _ _ 



PURCHASER IVIUST SEND ORDER AND COUPON TO PAYEE 



c5— 7155 



