Form 6001 



POST OFFICE DEPARTMENT NO. 



THIRD ASSISTANT POSTMASTER GENERAL sij^p „, |„ui„j am,, 



DIVISION OF MONEY ORDERS 



FEE 



The Postmaster 

 will insert 



here 



the office "drawn on, when the office named 

 by the remitter is in Alaska, and does not 

 transact 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 necessary, 

 by another person for him 



Amount — 



USE FIGURES. ] DnllflTQ Pptlfq 



DO NOT SPELL/ x>»onais y^enis 



To be 

 paid to . 



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



Whose 1 

 address > 



is ) Street 



City) 



and [• 



Statel 



Sent by 



(Name of sender) 



Street 



City] 



and > 

 Statel 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FEES SEE OTHER SIDE) 



05—7165 



