Form 6001 



POST OFFICE DEPARTMENT lift 



THIRD ASSISTANT POSTMASTER GENERAL ■""■ 



DIVISION OF MONEY ORDERS Stamp of Issuing OffiCS 



FEE. 



The Postmaster 

 will insert 



the office drawn on, when the office 

 named by the remitter does not trans- 

 act money-order business 



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 neceesai'y» 

 by another person tor him 



Amount — 



CSE *S?SF Ipell Dollars Cents 



-. . , Peter Henderson & Co. 



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



Whose) ^ _ 



^"Sf 35 Cortlandt St. street 



11} New York 7 ? N. Y. 



Sent by 



(Name of Bender) 



Street 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) c7— 16— 8391-2 



