Form No. 6001 



POST OFFICE DEPARTMENT NO 



THIRD ASSISTANT POSTMASTER GENERjiL Stamp ot Istuing Offlca 

 DlVISiON OF MONEY ORDERS 



The Postmaster 

 will insert 



here 



the cffics drawn on, when the ofince named by I ..Ji ' 



the remitter in the body of this npplidtion is not a Money Order Omce. 



Spaces above ihjs line are for the Posimasler's record, to be ftiied in by kim 



ApplicatioQ for Domestic Money Order 



Spaces below t:o be filled in by purcKasep, or, if necessary, 

 by anotKer person for him 



Amoiint 



. Dollars Cents 



Pay to Henry A. Dreer, Inc* 



OrderofJ -- ;-- 



(Name of rereon or Ciui for whom order is intended) 



i 1306 Spring Garden St; 



Whose 

 Address 1 



Is J No ."- -~ Street 



Post \ Philadelphia 



OlHeeJ 



Penna. 



State 



Sent by 



(Name of Bender) 



No. Street 



City) 

 and [ 

 State) 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



c5— 7158 



