(Form No. 60OI) 
fast Wt&te D^^iartmpnt NO. 
THIRD ASSISTANT POSTMASTER GENERAL Stamp Of Issuing Office 
DIVISION OF MONEY OROERS 
Tbe PostmaDter 
will Insert 
DOLLARS 
CENTS 
the office drawn on, when the office named by 
tbe remitter In the body of tUla application la not a Money Order Office. 
Spaces above this line are for tbe Postmaster's record, to be filled In b; blm. 
Application for Domestic Money Order 
Spaces below to be filled In by purchaser, or. If necessary, 
by another person for him 
Amount 
Dollars Cents 
o?^e*r°ot } J!iE TI LUN H 
(.Same of p«raou or Qru fur wLom orilct ia iul«udeU) 
Whose ) 
Address > 
Is J No.. 
Post ) 
Office ; 
LA.CONNER,. 
Rtate._„ .WASH. 
S«Dt by _ 
t.Nniufl ol Uvuilmj 
Address) 
of [ 
sender j No ; Street 
PURCHASEk .rtUST SEND ORDER AND COUPON TO PAYEB 
