Form 6001 
POST OFFICE DEPARTMENT No. ‘cad tlie 
THIRD ASSISTANT POSTMASTER GENERAL stamp of Issuing Office 
DIVISION OF MONEY ORDERS 
The Postmasier 
willinsert 
Hero meena re serra eee Pas 
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 mecessary, 
by another person for him 

Amount— 
aU E Sanh seas Dollars Cents 
Tobe | HART & VICK, INC. 
paid to laa se rors tena area 
: eeds - - Pi lants 
Whose \ameeeini tt © hs he) ae On eee re ee 
address} 47-55 Stone Street = 
MIT A oe ie Ne RSE Rae MRR NENT saa alge aia EROS Se fe rs Teet 
Cit 
and | Rochester, New York 
re) eee eee 
Ser Cai Yor ce ore a a ete et ee ee ee 
(Name of sender) 
ee ere ee ns ae Oe ee eee Street 
Oi | 
an 
FSG || a 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) c5—7155 
