A great original Treasury Department issued order form for Opium or Coca Leaves, or Compounds, Manufactures, Salts, Derivatives or Preparations! An earlier issue, from the 1920s, was recently shown on the History Channel during a program on illegal drugs. The Treasury Department used a dye to make this particular issue look very old, it's great in person. Please see photos!The form is ornate with a beautiful poppy graphic on the top corner. It was issued to Pharmacist, Winton Bloodworth, of Winton's Pharmacy in Macon, GA. An order for Dilaudid, Empirin & Codeine and Lilly ASA & Codeine, was placed on May 5, 1947 . This red duplicate was kept by the pharmacist for his records, the top original order form in black, was sent to McKesson-Robbins, Inc., in Macon, GA. The order form is large, 10 3/4" by 8 1/2", is watermarked, "United States Bureau Internal Revenue" and is in excellent condition! This is a fantastic piece of history and would be great to display in a pharmacy, museum or office! I am happy to answer any questions you may have, please feel free to email, thanks! Pleased to combine shipping with Prohibition Prescriptions, Opium Forms & Pharmacy Labels! As always, many thanks to my regular customers for your continued patronage!