Form 6001 
POST OFFICE DEPARTMENT NO. - 
THIRD ASSISTANT POSTMASTER GENERAL Stamp of Issuing Office 
DIVISION OF MONEY ORDERS 
The Postmaster 
will insert 
here__ 
lhe 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 (or 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 1 
Order of/_ 
(Name of person or firm for whom order is intended) 
Street ,i 
Whose | 
Address) 
Is J No. 
Post 1 
Office/- 
State 
Sent by___ 
(Name of sender) 
No_______ Street 
City ) 
and ) 
State]_ 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) 
c5—7155 
