'[Form No. 6001) 



P0Bt ©ffir^ Sr;iartmpnt 



THIRD ASSISTANT POSTMASTER GENERAL 

 DIVISION OF MONEY ORDERS 



No. 



Stamp of Itsning Oiiice 



The Postmaster 

 will insert 



DOLLARS CENTS 



^'§here 



ZI ^^e office drawn on, when the office named by the 



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



-^-- Spaces above tliis line are for tlie Postmaster's record, to be filled in by bin. 



ItApplication for Domestic Money Order 



^Amount 



;£Pay to 

 ^ cOrder of 



Spaces below to be filled in by purchaser, or, if nece»«iry, 

 by anotbex person for bim. 



Dollars Cents 



WM. HENRY MAULE, INC., 



rName of F>erson or firm for whom order is intended) 



r:>. Whose ) 

 :: iAddress >■ 



.ic is ) No.. 



itpost ) 



i ^Office! 



State 



PHILADELPHIA, 



Pennsylvania. 



£~Sent by. 



■r s.' 



t| 



Name of Sender) 



Address) 

 of [ 

 sender ) No Street 



PURCHA.SER MUST SEND ORDER .\NT) COUPON TO PAYEE 



