Form. 6001 
POST OFFICE DEPARTMENT No 
a THIRD ASSISTANT POSTMASTER GENERAL 
& 

DIVISION OF MONEY ORDERS Stamp of issuing Office a 
= 7 
= FEES a) 
5 4°) 
= The Postmaster ig 
will insert i 
herevees cee es ee peek a a EL if 
the office drawn on, when the office ® 
named by the remitter does not trans- 3 
act money-order business. Pus 
S| 
ped 
<£ Spaces above this line are for Postmaster’s record, to be filled in by him 0 
= Application for Domestic Money Order 3 
M. 


am 
(°) 
& Spaces below to be filled in by purchaser, or, if necessary, 3 
fe by another person for him “ 
(=) 
z Amount— qo 
USE FIGURES, 
rm) DO NOT SPELL ----------- Dollars -____---- Cents & 
> 
= 1. -).HOLMES SEED CO... & 
re paid to (Name of person or firm for whom order is intended) a 
rae 0 ASS ae a ec Eo c 
© Whose > 
— 

er i 
State | __________.________------------------------+--------------- 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) o16—8391 
