Keith Menin/Southpointe Heights, LLCm i gIA1`P'J6EACN
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 rewmmendation that foreseeably will be heard or reviewed by the city commission, or a city board 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.
MENIN, KEITH
NAME OF LOBBYIST: (Last) (First) (M.I)
2200 BISCAYNE BLVD. MIAMI, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700 305-847-3354 KEITH@CRESCENTHEIGHTS.COM
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
SOUTHPOINTE HEIGHTS, LLC
NAME OF PRINCIPAUCLIENT:
2200 BISCAYNE BLVD. MIAMI, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700 305-847-3354
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust
• 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:
DESIGN REVIEW APPROVAL FOR THE PARTIAL DEMOLITION, RENOVATION AND FACADE MODIFICATIONS TO AN
EXISTING BUILDING AT 42 COLLINS AVENUE.
Issue to be lobbied (Describe in detail):
lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4t32(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise 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) Any Financial, Familial or Professional Relationship
DESIGN REVIEW BOARD NO
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) $0.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $0.00
(Required).
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":
present or pending award for goods, eauipment or service?
2} Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes ~NO: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance to the City's Future Land Use
Map?
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 L7 No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of lobbyist:
`~~~~~~~N\FE~G~J~~~o~Principal/Client: _~'~
~``~ ~~? •~oM~+oroF ~~~YIST IDENTIFICATION:
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* ' '.e,~ ~ ~ro~litced ID
:~~#Dp759913 ,.°"^ _ Form of Identification
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99~A '~.°°9h J St StaY2`c~'~~``'~
~~~4ipB~~C, STATG~~' ~~~~onally known (Lobbyist)
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'Vll. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
Personally known (Principal)
' ~...
State of Florida, County of Miami-Dade
Swom to and subscribe before me
This r _day U , 2008
Sign tur blic ry - e of Florida
Nota zat o st' signature
of Principal's signature
OAYAMIAGUW-- R '
Notary Public -State of Florida
MA' Comn~io-- Expires Mar 16.201
Commission >K DD W1032
Bonded Through National Notary Apll
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registratlon'fee:~..[ . ,.] Yes [ ; j~No' °Amount Paid S MCR# Date Paid
:. ,,
Lobbyist,Registration Form received :and verified by; .
F:\CLER\LOBBYIST\Lobby'~st Registration Form 32708doc _ ` , ' ~ Revised 03%27/2008
State of Florida, County of
I do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Miami 8eoch, Florida 33139, www.miamibeochfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME
CityClerk@miam ibeochfl.gov
Y~ ~ ITS' /vl~ nrt~
I understand that no later than October 1st of each year, 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 of lobbyist withdrawal in writing.
~ ~ r~~,~~
Signature: Date:
F:\CLERILOBBYIST1Lobbyisfi Registration Form 32708.doc
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. 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.*
SOUTHPOINTE HEIGHTS, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
SOUTHPOINTE HEIGHTS HOLDINGS, LLC 100%
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
2200 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miaml, Florida 33137
Treasurer
PABLO DE ALMAGRO
2200 Biscayne Boulevard
Miami, Florida 33137
Asst. Treasurer
IF THERE 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 8
r
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. 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 stack 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.*
SOUTHPOINTE HEIGHTS HOLDINGS LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
CH INVESTMENT HOLDINGS, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
100%
OFFICERS
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A. MENIN
22D0 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
2200 Biscayne Boulevard
Miami, Florida 33137
Asst. Treasurer
lF THERE ARE ADQITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH /NDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
i
NOTE: Notarized signature required on page 8
6
CITY OF M1AM1 BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. 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.*
CH INVESTMENT HOLDINGS, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
SK BUSINESS TRUST 37%
2200 Biscayne Boulevard
Miami, Florida 33137
Member
RF BUSINESS TRUST 37%
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MENIN 1998 FAMILY TRUST 26%
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
lF THERE 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 8
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 entity, 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
SONI~tY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
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, 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 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
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
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, 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 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 1998 FAMILY TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
100%
NOTE: Notarized signature required on page 8
7