Form 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 is in Alaska, and does not transact money-order business. 
Spaces above this line are for the Postmaster’s record, to be 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 
Pay to \ 
Order ofj _ 
(Name of person or firm for whom order is intended) 
Whose | 
Address! 
Is J No._Street 
Post \ 
Office/- 
State 
Sent by_ 
(Name of sender) 
No. .. 
City ■ 
and 
State, 
Street 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
c5—7165 
