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REPORT OF RECEIPTS FEC AND DISBURSEMENTS FORM 3 For An Authorized Committee Office Use Only
1. NAME OF TYPE OR PRINT Example: If typing, type 12FE4M5 COMMITTEE (in full) over the lines. Robert Hurt for Congress
PO Box 8 ADDRESS (number and street)
Check if different than previously Chatham VA 24531-0008
reported. (ACC)