Russell W. Galbut - 730 First Street Associates ? M IAMI.BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
1 LOBBYIST REGISTRATION FORM
1 Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or
I modification of any ordinance, resolution, action cr decision of any commissioner, any action, decision, recommendation of the City
I Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time period of the
entire decislon- making process on such action, decision or recommendation 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 exc lusions. Please refer to Ordinance 20044435.
Galbut Russell W
NAME OF LOBBYIST: (Last) (First) (M.I)
2200 Biscayne Blvd. Miami Fl .. 33137
I BUSINESS NAME AND ADDRESS (Number aid Street) (City) (State) (Zip Code)
305- 573 -4127 305 -573 -8489 rgalbut @crescentheights.com
TELEPHONE NUMBER:f FAX NUMBER: EMAIL:
Please notify thls ffice if your contact Information changes: address, phone, or e-mail address.
I. LOBBYIST R AINED BY:
730 First Street soclates, LLC
. NAME OF PRINCiPAUCLIENT: .
1665 Washington Ave, 4th Floor, Miami Beach, FI. 33136
BUSINESS NAME AND y DDRESS (Number anc Street) (City) (State) (Zip Code)
305 - 573 -4127 _
TELEPHONE NUMBE FAX NUMBER: (Optional) EMAIL (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2.482 (c)1
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: NF First Street, LLC - 50 % Ownership
BK First Street, LLC - 50% Ownership
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
' PARTNERSHIP OR TRUST:
ii.SPECIFIC LOBBY ISSUE: 22 c 11 r �
Any and all Issues �? 1� a L ✓O g6�1 1 �'' S A" . - .&i t , (`* a�.r -d S t • 31- Pk./NCI .
Issue to be lobbied (Describe in detail): c` (• a
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: 1.410 ` l��s5 ( PR��.�,�,
Pursuant to City Code Section 2482(a)(4) Include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the preset date, stating the general nature of the.sub)ect contractual relationship.
Sec 2-482(aX4) Full Name of individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Planning Board X
Design Review Board . X
Pursuant to City Code Section 2.482(gI Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who Is
sought to be lobbied as Identified on the lobbyist rejistration form filed. 3i d S }� 3 A/13
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION ( DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER): �r
A) LOBBYIST DISCLOSURE: (Required) (�l CI
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): p,, 0
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
❑ Yes lo: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending
award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
❑ Yes k-No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change 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 on y appears as a representative of a not - 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 ❑ No: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR. ACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDIT RES, AS ELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatur of obbyist
I do solemnly swear that all of the foregoi -g facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City ;,ode , • • all reporting re /• r
Signature of Lobbyist: �- -
Signature of Principal /Client , �i
—♦ — —
VI. LOBBYIST IDENTIFICATION: o o PRINCIPAL IDENTIFICATION:
O co N _
❑ Produced ID a o I Produced ID " rA�1 l"VIUb T o 1
Form of Identificatio ; r w FL0L Form of Identification ,8 cN N
a cn °' O o I
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q( Personal) known Lobb ist > a w w Y (Lobbyist) ) ❑ Persona l l y known (P ri nci p al) a ..
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VII. SIGNATURE AND STAMP OF NOTA Y: c �, ° a j w N
z oa E E
State of Florida, County of Miami -Dade ,,,,,, , State of Florida, County of Miami -Dade = E o
Sworn o- nd subscribggd before me 4'-' '� Sworn • subsc . ed before me _. ; c.) Th /;: • day of � t om, 2011 _' e 1 „, This �. day of , 2011 Z
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Sign- ure f. Public et State of Florida _ I �,,,,_, _ Sign ture f Public Nld tary - State of Florida 1 � ' 1� ,
Nota zati • of Lobbyist' signature Notarizati n of Principal's signature '`ti •, SA P ,;=
TO BE COMPLETED BY CITY CLERK'S STAFF ON
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ . , 0 MCR # ,, 7 7i7---J / D to Paid ' I
Lobbyist Registration Form received and verified by: 1 //
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc 1 ' Revised 1/11/2011
CI MIM1 H
City of Miami Beach, 1700 Convention Center rive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Russell Galbut
I understand that no later than Fe
J)
ruary 28th of each year, I must file the following
form, pursuant to Section 2 - 485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issu ' .
1) Lobbyist Expenditure and ompensation Form
Y p p
Failure to file these forms on a tim ly basis will result in my name being transmitted to the
Miami -Dade County Commission n Ethics and for code violation evaluation.
In addition, once an issue I have egistered to lobby on has been resolved, I am required
to immediately notify the City Cle k's Office of lobbyist withdrawal in writing.
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Signature: Date:
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