Form No. 6001 



POST OFFICE DEPARTMENT 



THIRD ASSISTANT POSTMASTER GENERAL 

 DIVISION OF MONEY ORDERS 



The Postmaster 

 will insert 



No. 



stamp at Issulni! OBIce 



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 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 him 



Amount 



Dollars Cents 



SrL?of}Menjry.A, .Dreer^Jac,^ 



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



Whose 



n^^^U 1306 Spring. Garden ^S^^^^^ 



&} P.^.i]MeJpMa 



State ....Pe»na_! 



Sent by_ 



No 



City 1 

 and } 

 State) . 



(Name of Bender) 



.Street 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



cS — 7165 



