04/15/2014 11 : 48 Image# 14960698003 PAGE 1 / 172
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. Michael Grimm for Congress
PO Box 61806 ADDRESS (number and street)
Check if different than previously Staten Island NY 10306-7806
reported. (ACC)