Casey Kleinm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action,
decision, recommendation of the City Manager or any city board or committee; or any action, decision or
recommendation of any city personnel during the time period of the entire decision-making process on such action,
decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city bond or
committee. The term specifically includes the principal as well as any employee engaged in lobbying activities. The
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Klein Casey
NAME OF LOBBYIST: (Last) (First) (M.I.)
2200 Biscayne Boulevard Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5700 (305) 847-3354 cklein@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
South Beach Heights I, LLC
NAME OF PRINCIPAUCLIENT:
South Beach Heights I, LLC 2200 Biscayne Boulevard Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 3745700 (305) 847-3354 mkramer@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Russell W. Galbut
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See attached.
II. SPECIFIC LOBBY ISSUE:
Redevelopment of former South Shore Hospital assemblage and nearby properties, including properties between
6th and 8th Street on both the east and west sides of Alton Road.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual/Title B An Financial, Familial or Professional Relationshi
City of Miami Beach Planning Board None
City of Miami Beach Design Review Board None
City of Miami Beach Planning Staff None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Land Use & Development None
Committee
City of Miami Beach Committees None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE• (Required) $0. No additional compensation for lobbying.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $0 No additional compensation for lobbying.
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes 6d No• Are you lobbvina on a present or pending bid for goods eauigment or services. or on a
present or gendina award for goods eauigment or service
2) Pursuant to Miami Beach City Code 290 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
®Yes ^ No• Are you lobbving on a gendina application for a Development Agreement with the City or
application for chance of zoning map designation or change to the Citv's Future Land Use Mag?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes 6a No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
R
VI. LOBBYIST IDENTIFICATION:
each Heights I, LLC
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
.0 Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
^ Produced ID
Form of Identification
~) Personally known (Principal)
State of Florida
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t. ~mi- a e OAYAM County of
State of Florida '-
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IaGUTAR ,
Sworn to and sus ntNeta Publc -State of Florida
- Sworn o and su
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Notary Public -State of Fbrfda
h i day of - EaDires Mar 18, 2011 i
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.
' ~ bonded Through National Notary Assn. r Commission f OD 644032
Si atu of Publi Si natur of Public ota - tat~~ oriThrougnNationelNotaryAm.
Notarization of Lobbyist's signature No riza on of Principal's
i TO BE COMPLETED BY CITY CLERK'S USE ONLY / ~
Form received and verlfled by: _
bbvist Reoistration Form 32708.doc
I do solemnly swear that all of the foregoin,~fact~/are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 oft Mia i Beach City Code and all reporting requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerktia~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Casey Klein
I understand that no later than October 1St of each vear, I must file the following forms, pursuant to Section 2-485 of
the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County
Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office r lobbyist withdrawal in writing.
/~ ~~~~
Signat sey Klei Date:
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISGL~SURE OF INTEREST
't. LIMITED LIABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation{s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SOUTH BEACH HEIGHTS ! LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
SBH HOLDINGS I, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member
SBH MANAGEMENT COMPANY, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
OFFICERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W. GALBU7
22D0 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Sr. Vice President
SHARON CHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33137
Vice President
SHLOMO DACHOH
2200 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miami, Florida 33137
Treasurer
PABLO DE ALMAGRO
22DD Biscayne Boulevard
Miami, Florida 33137
Asst.. Treasurer
OF MEMERSHIP INTEREST
99%
1%
IF THERE ARE ADDITIONAL CDRPDRATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY t~F MIAMt BEACH
DEVELOPMENT REVIEW BOARD APPL1CATtON
DfSCLOSURE OF INTEREST
1. LIMITED LEABILlTY COMPANY
If the property which is the subject of an application is awned or leased by a CORPORATION,
[isf the principal stockholders and the percentage of stack owned by each. Where the principal
officers or stockholders consist of another corporation{s), trustee{s), partnerships} or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SBH MANAGEMENT COMPANY LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
CH INVESTMENT HOLDINGS, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
OFFICERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A_ MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Sr. Vice President
SHARON CHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33137
Vice President
SHLOMO DACHOH
22D0 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miam[, Florida 33137
Treasurer
PABLO DE ALMAGRO
22D0 Biscayne Boulevard
Miami, Fiorida 33137
Asst.. Treasurer
OF MEMERSHIP INTEREST
100%
IF THERE ARE ADDITIONAL CORPORATIONS, UST OTHERS, INCLUDING CORP,
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, .OFFICE AND
PERCENTAGE OF STDCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABIL)TY COMPANY
If the property which is the subject of an application is owned or leasetl by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons} having the ultimate ownership interest in the entity.* .
SBH HOLDINGS 1 LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
CH INVESTMENT HOLDINGS, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
DAVID GALBUT
2200 Biscayne Baulevard
Miami, Florida 33137
Member
OFFICERS:
50NNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 3313'7
Sr. Vice President
SHARO~iCHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33'137
Vice President
SHLOMO DACHOH
2200 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miami, Florida 33137
Treasurer
PABLO DE ALMAGRO
2200 Biscayne Boulevard
Miami, Florida 33137
Asst.. Treasurer
OF MEMERSHIP INTEREST
89.89%
10.11%
lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH /NDIV/DUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEV1l BOARD APPLICATION
DISCLOSURE OF INTEREST
'1. LIM[TED LIABILITY COMPANY
if the property which is the subject of an application is awned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure steal} be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
CH INVESTMENT HOLDINGS LLC
LIMITED LIABILITY COMPANY NAME
NAME, ,4DDRESS, AND OFFICE % OF MEMERSHIP INTEREST
SK BUSINESS TRUST
2200 Biscayne Boulevard
Miami, Florida 33137
Member
37 °/a
RF BUSINESS TRUST
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MENIN 1998 FAMILY TRUST
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MANAGERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
RUSSELL W.. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
37°10
26%
lF TNERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE - AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page S
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar enti#y, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SK BUSINESS TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE % OF INTEREST
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33{ 37
Beneficiary
X00%
NOTF: Notarized signature required on page 8
7
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
if the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. ~lVhere the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
RF BUSINESS TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE % OF INTEREST
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
100%
NOTE: Notarized signature required on page 8
7
ciTY of MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of an application is owned or leased by a TRUSTEE, fist the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
MENIN 1J98 FAMILY TRUST _
TRUST NAME
NAME, ADDRESS, AND OFFICE % OF INTEREST
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
100%
NOTE: Notarized signature required on page 8
7