Form 6001 
POST OFFICE DEPARTMENT 
THIRD ASSISTANT POSTMASTER GENERAL 
DIVISION OF MONEY ORDERS 
The Postmaster 
will insert 
here....... 
the office drawn on, when the office named by L___ 
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 
No... 
Stamp of Issuing Office 
Dollars_Cents 
Pay to 1 
Order of J_ 
(Name of person or firm for whom order is intended) 
Whose 1 
Address I 
Is J No._Street 
Post 1 
Office/- 
State 
Sent by 
(Name of sender) 
No._ _ _Street 
Cityl 
and > 
StateJ_ 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
c5—7155 
