Money Order Inquiry
Money Order Serial No. (As shown on original receipt)
Date on Original Receipt (MM-DD-YYYY)
Money Order Amount
$
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Certication and Signature
I understand that anyone who furnishes false or misleading information on this form may be subject to criminal sanctions (including nes
and imprisonment) and/or civil sanctions (including multiple damages and civil penalties). I agree to repay the Postal Service
™
, upon
demand, the amount of the refund if the designated payee, purchaser, or nancial institution cashes the original money order. The rights and
remedies set forth in 18 U.S.C. 287, 18 U.S.C. 1001, and 31 U.S.C. 3802 shall be incorporated as if fully set forth.
Post Ofce No. (As shown on original receipt)
Purchaser’s First Name (Not for Bank Use)
Bank Use or Post Ofce Only (Bank/Financial Institution Name or Post Ofce)
Mailing Address (For mailing refund, correspondence, or copies)
City
ZIP+4
®
Telephone No. (Optional) (Include area code)
ABA No. - Bank Use Required
MI Purchaser’s Last Name
Apt. or Suite No.
State
Country (If applicable)
International Telephone No. (If applicable)
Reference No. - Bank or Post Ofce Use Only
Signature of Customer Filing the Money Order Inquiry Date Signed (MM-DD-YYYY)
Privacy Act Statement: Your information will be used to respond to your request. Collection is authorized by 39 U.S.C. 401, 403, and 404; 31 U.S.C. 5318, 5325,
and 5331. Providing the information is voluntary, but if not provided, we may not process your transaction. We do not disclose your information to third parties
without your consent, except to facilitate the transaction, to act on your behalf or request, or as legally required. This includes the following limited circumstances:
to a congressional ofce on your behalf; to nancial entities regarding nancial transaction issues; to a U.S. Postal Service auditor; to entities, including law
enforcement, as required by law including anti-money laundering statutes and regulations, or in legal proceedings; and to contractors and other entities aiding us to
fulll the service (service providers). For more information regarding our privacy policy visit us at usps.com.
POST OFFICE: AFFIX STAMPS
OR METER STRIP HERE
After you le an inquiry, you can check the status by calling our toll-free number 1-866-974-2733.
Mail to: St. Louis Accounting Service Center
General Accounting Branch
PO Box 80453
St. Louis, MO 63180-0453
By presence of this signature, I have veried the customer receipt presented by the purchaser.
Customer’s Photo ID No.
Finance No. of Accepting Ofce
No-Fee Money Order Serial No. (If applicable)
ZIP Code™ Telephone No. (include area code)
ID Type: e.g., Driver’s License or State Issued ID, Military ID, Alien Registration, Passport
Date (MM-DD-YYYY) Amount
Date Inquiry Filed (MM-DD-YYYY)Signature of Postal Service Employee
Post Ofce ID
0 1 1
PS Form 6401, August 2016 PSN: 7530-02-000-9536 (Page 1 of 2)
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$
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9 9 9 9 9 9
For Postal Use Only
SECTION A
— Use Black Ink ONLY and Print Within the Boxes.
File an inquiry about a money order any time after purchase as follows: You can get a copy of a cashed money order or request a refund as follows:
File the inquiry at any Post Ofce.
Use one form for each money order.
You must pay a separate fee for each form (i.e., money order inquiry).
Complete all blocks, sign, and present your customer receipt to the Post Ofce employee. The
employee will verify the information you provide.
We will issue a refund 60 days or later from the issue date of the money order, or provide a copy of the
money order if it has been cashed.
SECTION B
—
THIS AREA IS FOR OFFICIAL USE ONLY