Page:United States Statutes at Large Volume 21.djvu/789

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Model B (1 ). Model B. UNITED STATES OF AMLERIC L. UNITED STATES OF AMERICA. ETATSUNIS UAMERIQUE. mTA1*s.UMs DAMERIQUE. _.§’EBPk?.1“@f; T- _,,.__..___;__;q.j’;___._"'* -__,,__, __ A M __>_ li°· 7;; E; Stamp of xssuing office. . Amount in ngurm é Stamp of issuing omee. Amount in Hgumm g Somzne en clmfres, I Somme en chlhes, E €_ AdVi°° United States money: Q United States money: Q of Monuaie des Etats·Unis : 0 _ Monnule des Etm;s·Unis ; EU g International money order __A””r_ _ International money order. "" "" *”'"`”“" € $ E Avis M _><V Mandat de poste international. $ {sj S d’émission Fqmign money. 5 Fomigu money I U Q _ d’1u1 mandat do poste International Mmm“1°d“P”Y¤étTm8°?* 8 Monnaie dn puysetrxmger: G é ‘_’_“‘_"‘°’“ ¤ ·······*·~·~v~v O

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Drawn b the above-named ofllce on the 88 P¤»y¤bl0 by H10 ¤fH¤e M Tiré vgrble burgu <=i—6¤¤¤¤¤ <1é¤is¤6.l¤ } ·-v·—*d°y °fv·——··"j"];]"" 1 f ’ —s---—,~..- _..-.,. , ,]€W5f&l>l9_l1*B”,l$>j>1¤§<?_¤1\} je __ _ ___ r__ _ M V___ W M___ E “P°“ t ° 9**** ° °° M °* ° sum ° Pay to the person named in my letter of advice of this date`No. abov N desi lated the sum of sur 16 buwu d° _§_ __A _ __ ___ _ __Y&)gEEE_ P9»y¤Z B 151 PBPSOHDB nommée dans ma lettre d’avis do oe jour,’No. oipdesgus dgggnéfla somme de g The épayee, viz: The person to whom the order is lpayablo; v__ A`*_“_"`* """‘“`""’“`'``` I Ben nciaire: La ersonne au prodt de qui le man thest tire. AM__ Issued by the above named post odioe g 188 Given name (prenoms). \ gufnamo (nom). Tixé PM 0 b‘“`°"·“ °i"1°““s déB*g¤é· 1** "*“·"‘‘ G _' Resnlence of the payee. Residence du benedeiaire. Poatmaowr.E Street and number. City or town. Degartment, 0|l·I1t0I1,0P county. Dwymt du P08m- P Rue ei; pumém, Ville on village. __ épartement ou canton. ______;__ _ ¤

   —-——-—-—-@ @ M _ §>

The remitter, viz : The person who purchased the order. 5. Uenvoyeur: La personnpigui e. vers 1’ar@. i4>i_ n, Given name (prenoms). ‘ Surname (nom). X., the postmaster at _ ¤ E Monsieur Pagent des postes a g Residenoe of the remitter. A_ _ nkesidence de Penvoyeur. _ M_ .--.t-- A, *4 Sa t ii B `.A *‘i‘ '”"‘c166i· sown. T ‘` ’‘’’ ‘ sm . i -—--—-— ¤ gse gtlndlmgroér \ Ville ou village. \ Eta:. E E

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gggtmvgé , m Q ’agen pos .

S%p7)?i).»-—»—&yi¤g omca Received the amount of the above order a.b§  E

g` Been le montant du maudat oi-dessus a 1e _ __________________ 188 _ " ¤¤ r- . . . °· Signature of the person to whom the order is paid. 00 This ad ce should be dated, si ed, and stamped by the post- ¤ · _ · master wig issues the order, and égmped upon its receipt by the S Slgmtum d6 le P°”°1m° 3* qw 1° mmdat °°t Yayé' postmaster of the office upon which it is drawn. Q Qet avis doit etre date, signe et timbre par Pagent des postes qui g e tire Ie mandat, et timbré, des sa réoopt OD ·-c Eeither the issuing nor the paying postal administration is liable to any claim for an order , . E which has once gesn paidé t d h f if me d "J eaemen ’unmana eose,une oie , li 8, B- E contrg lyadministration qui n emzg le mandat, Mgt ooftrre cxe qgglig pgyéé ucuu mcoum mt g