Russell W. Galbut Annual Lobbyist Registration Form (2) MIAMI EAC H a5' r op)
City of Miami Beach j-9
1700 Convention Center Drive CIA,`�
Miami Beach, Florida 33139
www.miamibeachfl.gov
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: vC C /6(-*
Business Name: -`'
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Telephone Number: - JJ
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Email Address: C r 6 L/ s'C G►
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If more than one lobbyist,please list:
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Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#: 0 `t N
Amount paid: X Date paid: t 2c
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CITY HALL CASHIER OFFI ;# ' `U £4,`
1700 CONVENTION CNTR DR `•�
MIAMI BEACH, FL 33139 _ .,.
01/28/2015 13:24:23
Merchant ID: 000000005148978
Terminal ID: 02013135
1090573940
CREDIT CARD
AMEX SALE City of Miami Beach-Florida
CARD# )000000000(1057 Finance Department
INVOICE 0017
Batch#: 001454 1 City Hall
Approval Code: 565020 1502813-1 01/28/2015 BR1 T121
Entry Method: Swiped Wed ,Jan28,2015 01 :25PM Trans#51-5 i
Mode: Online 5 i $500.00 MCRCLERK - MCR-City Clerk
MCR#: 401440
SALE AMOUNT $500,00 1 ITEM(S): TOTAL: $500.00
Credit Car PAID $500.00
Have a nice day!
CUSTOMER COPY
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