Form. 6001 
POST OFFICE DEPARTMENT NO. .. 
THIRD ASSISTANT POSTMASTER GENERAL ^ Issulnj Office 
DIVISION OF MONEY ORDERS 
FEE 
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. 
Spmcet above I his line are for the Postmaster’s record, to be blled 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— 
USE }_Dollars_Cents 
pIra^o}-MIMERSEED& 
(Name of person or firm for whom order is intended) 
Whose 1 
address > 
is )-Street 
eSI FARIBAULX.^M^^ 
Sent by __ 
(Name of eender) 
Citvl 
and > 
State I- 
Street 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) oS—7165 
