Form No. 6001 



POST OFFICE DEPARTMENT NO. 



THIRD ASSISTANT POSTMASTER GENERAL Stem; »f Issuing Office 



DIVISION OF MONEY ORDERS 



The Postmasta 

 will insert 



here.. 



the office drawn on, when the office named by 



the remitter is in -Alaska, and does not transact mon ey order business. 



Spaces alMTe this iine are f«r the Fvslmaster's record, t» be filled in bj him 



Application for Domestic Mosey Order 



Spaces below to be filled in by purchaser, or, if necessary, 

 by another person for him 



Amount 



Dollars Cents 



(Name of i>erso3 of Grin for wh.om order ia intended) 

 TCThoSO ) 



''''i^*^}No.....J.^.P.^...SpAJn.g..^.?.ri?^.^...StA^ 

 } _ Philadeiphia^ 



Pesina. 



Post 

 Office 



^^^^ State 



Sent by. 



(liamo of Becdex) 



No. Street 



City] 

 and > 

 State) 



PURCH.4SER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE GTHEIR SIDE) 05—7165 



