Form 6001 
POST OFFICE DEPARTMENT No 
THIRD ASSISTANT POSTMASTER GENERAL 
DIVISION OF MONEY ORDERS Stamp of Issulng Office 
et ee ee 
FEES os 
Tho Postmaster 
will insert 
ge epics, oie aM LAVA Sella Toh 
the office drawn on, when the office 
named by the remitter does not trans- 
act money-order business 
Sa i eo bal 
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 necessary, 
by another person for him 
Amount— 
USE FIGURES, 
DO-NOT SPELL --------—-- Dollars 
Tobe } OROL LEDDEN & SONS 
Paid:tel score of back Ge find fae Who cede 
ee a ae ee 


Sent: by coe ee ee eee 
(Name of sender) 
Saree metal eae iva A att al A Be ace la Street 
City 
and 
State 
PURCHASER MUST SEND ORDER AND COUPON TO PAYEE 
(FOR FEES SEE OTHER SIDE) c7—-16—8391-2 
a ee 
SS EL RA OS SY SS ke ee ee ee eee 
