5 1 ■ Application for Money Order. 
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..Dollars. 
.... Cents. 
John Lewis Childs, 
g^-SCity or town. 
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Street and No... 
FLORAL PARK, 
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N. Y. 
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|Sent by— 
Address of sender : No_ 
..Street. 
Fees Charged for Money ©rders 
For payment in United States, in Hawaii, in Porto Rico, 
and in the Philippines. 
JTor Orders for sums not exceeding $2.50 . 3 cents. 
Over $ 2.50 and not exceeding $ 5.00 5 cents. 
Over $ 5.00 and not exceeding $ 10.00 8 cents. 
Over $10.00 and not exceeding $ 20.00 10 cents. 
Over $20.00 and not exceeding $ 30.00 12' cents. 
Over $30.00 and not exceeding $ 40.00 .....15 cents. 
Over- $40.00 and not exceeding $ 50.00 18 cents. 
Over $50.00 and not exceeding $ 60.00 20 cents. 
©ver $60.00 and not exceeding $ 75.00 25 cents. 
©ver $75.00 and not exceeding $100.00 .30 cents. 
4®-The war tax is not a part of the fee, but is collected (two 
cents for each order, whatever its amount) from the remitter, 
in the place of a revenue "^amp, which stamp is not required on 
a Postal Order. 
Memoranda of Issuing Postmaster: 
Note.— The maximum amount for which a single Money Order 
may be issued is $100. When a larger sum is to be sent, additional 
Orders must be obtained. 
Applications must be paeserved, at the office of issue, for four 
years from date of issue. 
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