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 b; 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) 
Whose 
Address 
Is 
No. 
Street 
Post 1 
Office/ 
State 
Sent by_ 
(Name of sender) 
No. 
Ci^ j 
and 1 
State] 
Street 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) 
c5—7156 
