fast ©fitrp 
THIRD ASSISTANT PC 
^ DIVISION OF K 
The Postmaster 
will Insert 
here 
the ofllce drawn on, when the office named by 
the remitter lu the bodj' of this applloatlon Is not a Money Order Office. 
Spaces above this line are for the Postaaster's record, to be filled la by bim. 
Application for Domestic Money Order 
Spaces below to be filled In by purchaser, or. If necessary, 
by another person for him 
Amount 
„ Dollars Cents 
g^efof } XH|E..IILy NG.H A 
(Name or person or firm ror wbom order la loteDdod) 
(Form No. 6001) ' ^ 
ifpartmpttt NOi 
>STMASTER GENERAL Stamp of l««ulng OfflM 
lONEY ORDERS 
Whose ) 
Address > 
Is J No. Street 
oml } LA..C.QNIS£R, 
^tate W-A&Hv 
Scot by.. 
(Name or Sender) 
Address) 
of V 
sender J No. „ Street 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
