Form 6001 



POST OFFICE DEPARTMENT Mn 



THIRD ASSISTANT ?OSTM»nT» GENERAL •'"• 



DIVISION OF MONEY ORDERS SltTif ft \tUtH OfflC* 



FEE 



Jbt P'jstmaster 

 vlll tnsen 



tb* ofBoe drawn on. when tb« office 

 nained by tbe remitter does not trmns- 

 aet money-order business 



%irM aWf* |U( En* ar« iar lb* Paalaaslac'i rccird. la b« filial in by him 



AppHcation for Domestic Money Order 



Space* balow to b« filled in by purchiaser, or, if neceasary, 

 by another person for him 



Amount — 



BSE FIGLRES. r»^n„-„ 



DO MOT WELL JJOUaTS 



Cents 



Toba 1 





paid toi (Nm 



>a a< pvaoo or firm for vboB oniar i* iataodad) 



WbOM 

 address 



U 



Street 



?tate 



S«nt bx ... --. .. - ... 



State 



(Nam* of Madwj 



„ - „ Street 



PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 



(FOR FE£^ SEE OTHER SIDE) cift-83»i-2 



