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 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 
Order o J ^Nafcfct per^fc l^&£JEljnd 
tided) 
----R°cIdord--SeecI--F*FnFt5 — Forest-City- -Cr-eeRbouses 
Address 1 
Is I No_ 
Post 
Office 
_Street 
- ROCKFORD- - 
State- tH-tFJOlS- - 
Sent by_ 
(Name of sender) 
No._Street 
City] 
and > 
State) _ 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) o5—7155 
