Form 6001 

 POST OFFICE DEPARTMENT 



g^ THIRD ASSISTANT POSTMASTER GENERAL 



Q DIVISION OF MONEY ORDERS jlanip Ol iKUlBg OfflM „ 



O O 



FEE. 



M 

 ^ The Postmastar ^ 



will insert fi 



< V 



5 here C/3 



sp tha office drawn on, when the office » 



j named by the remitter does not trans- 3 



_] act money-order business. •** 



:5 "^ 



g Spaces above this lino a?e for the Posfnisstcr's record. So ba filled in by fcim 2 



I Application for Dsmes^c Money Order! 



§ Spaces below to be filled in by purcbasery or, if necessary, (^ 

 by another parson for him ""^ 



° Amount — % 



S USE FIGURES, Tk^n^^o, n^v^i^ »* 



^ DO NOT SPEU, JDoilars Uents s? 



I To be 1 .E:?l!^l.-IJjil?4§i;!^5i-.^-.^l fO 



^ paid toj (Name of rwraon or firm for ^F^om order ia intend^) 



5s "Whose 1 -------- - — -— -— — ^ 



fe^'-^TsI 3 5 Cortlandt St. ,^^^r 



S and 

 S State 



IS ) z . oireei. gj 



It [ New.,Xark.....N-...Tl 



52 Sent by o 



Gi (Name of Bender) {It 



< 



O Street S 



§ Oity 1 -^ 



and > 

 O State J 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) oie— 8381 



