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TitleReport of Missing Coupons
FormNumber43
RevisionNov 19, 1875 at lower left corner
DivisionInternational Money Order Business
WhereUsedNew York, NY
EKU1877
LKU 
NotesForm number at top center shown as (No. 43.). The form was completed by the postmaster at Ells, ME and sent to the postmaster at NEw York. The words "None Drawn" are written across the body of the form. The purpose of this form is not obvious, but appears to be a check on a form issued previously. Collection of MikeL
SourceMikeL