Form 6001 
POST OFFICE DEPARTMENT No 
THIRD ASSISTANT POSTMASTER GENERAL Bola coec wae fa cheare cameo 
DIVISION OF MONEY ORDERS Stamp of Issulng Office 
FEE 
The Postmaster 
will insert 
“hhete 2 Pie. 2 ee a ee ees 
the office drawn on, when the office 
named by the remitter does not trans- 
act 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 necessary, 
by another person for him 
Amount— 
USE FIGURES, | 
DO NOT SPELL ----------- Dollars ___...... Cents 
To be } 
paid to 

W hose IGA a i Mac tani sine ce pe 
address 
is 
City 
State 

(FOR FEES SEE OTHER SIDE) o7—16—8391-2 | 

