Form No. 6001 
POST OFFICE DEPARTMENT NO.--- 
THIRD ASSISTANT POSTMASTER GENERAL Stamp of Issuing Office 
DIVISION OF MONEY ORDERS 
The Postmaster 
will insert 
here—...I_ 
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 
State 
Sent by_ 
(Name of sender) 
No. _ 
City 
and 
State 
_Street 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) c5—7155 
5TOP ! before you seal this, look carefully and see if you 
^ have YOUR name and address written plainly 
r * ^ ^ -v-n irr oonro 
