Form 6001 



es POST OFFICE DEPARTMENT i 
ran} THIRD ASSISTANT POSTMASTER GENERAL , 0 ra par cl ps ase ay 
& DIVISION OF MONEY ORDERS Stamp of Issulng Office B 
me aw 
a = ee a) 
S ~~ 
S The Postmaster ti 
_** will insert A 
«gt! 
5 Pere I. ge hTe sae eS 
fA the office drawn on, when the office @ 
named by the remitter does not trans- =} 
a act money-order business. Ds 
3 Spaces above this line are for Postmaster’s record, to be filled in by ie: 
@ Application for Domestic Money Order : 
= Spaces below to be filled in by purchaser, or, if necessary, 5 
f2 by another person for him te 
© 
. Amount— a 
<r USE FIGURES, 
a DO NOT SPELL ----------- Dollars 2xxc.2! Cents 4 
> 
= To pe PIO MRN Le ew R eMac) Nee Nghe foal TL bt 
Ee paid to (Name of person or firm for whom order is intended) ee) 
A lil BEG Jes VERE, el te Ne a NL eo Ks 
© Whose > 
address = 
Ps US} oe se eh te ees a Street 
ity ® 
rs and 9 
= State [ese Sle ee a ee ee LT Las ea EE Q, 
a Sent b 5 
eC oa eee ke ee eee enn aaamninnina walahe te eehe! 
ee -! (Name of sender) oe 
fm hme 
S poate ar tomer ont rite mkanmee era ot es Street § 
i 4 
eg 
FSP RE cel Rene AMM SERINE Yee et 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) c16—8391 
