Form No. 6001 
POST OFFICE DEPARTMENT NO- 
THIRD ASSISTANT POSTMASTER GENERAL Stamp of Issuing Office 
DIVISION OF MONEY ORDERS 
The Postmaster 
will insert 
here--- 
the office drawn on, when the office named by 
the remitter in the body of this application is not a Money Order Office. 
Spaces above this line are for the Postmaster's record, to he 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 
_Dollars_Cents 
Order of} _ _VAN .ANTWERP.15.EEJD._CCL_ 
(Name of person or firm for whom order is intended) 
Whose 1 
Address > 
Is I No_ 
offlU-_M?JW1 «jl._ 
State ....Alabama 
_Street 
Sent by_ 
(Name of sender) 
No._Street 
City ] 
and } 
State) _ 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
c5—7165 
