Russell W. Galbut - Southpointe Heights, LLC M1AM1BEA H
City of Miami Beach Office of the City Clerk
1700 Convent n Center Drive, Miami Beach, FL 33139
L BBYIST REGISTRATION FORM
Lobbyist means at 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 r derision of any commissioner, any action, decision, recommendation of the City
Manager or any city board or committee; or any a on, decision or recommendation of any city personnel during the time period of the
entire decision- making process on such action, Sion or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The rm specifically includes the principal as well as any employee engaged in lobbying
activities. The term "Lobbyists" has specific ex Iusions. Please refer to Ordinance 20044435.
Galbut Russell w
NAME OF LOBBYIST: (Last) (First) (M.I)
2200 Biscayne Blvd. Miami FI 33137
BUSINESS NAME AND ADDRESS (Number and Street) (Cfty) (State) (Zip Code)
305 - 573 - 4127 305- 573 -8489 rgalbut @crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e address.
I. LOBBYIST RETAINED BY:
Southpointe Heights, LLC
NAME OF PRiNCIPALJCLIENT: •
2200 Biscayne Blvd. Miami FI 33137
BU30. AND ADDRESS (Number anc Street) (City) {State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
g.SPECIFIC LOBBY ISSUE: •
Any and all Issues (` N rC..a, , (-1 C, . t'c. : c, p r V r4v(2,
Issue to be lobbied (Describe in detain: VI AS
u1. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: k. A T\ ; De c� ; ,g Gigs i
Pursuant to City Code Section 2.482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered \CP"
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 present date, stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4) 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 Suction 2.482(8) Every registrant shall be required to state iit� ppa�ctt nt of any business, financial, famnlal or professional
relationship, or other relationship giving rise to an appearance of an Impropriety, Mi t VaiUF )rrie t cllty commissioner or city personnel who Is
sought to be lobbied as Identified on the lobbyist registration form tiled.
Sec 2-482(g) Any Financial, Familial or Professional Relationship 09 ,1 8 1 ' 1 .. J i
Nor llgZ
IV. DISCLOSURE OF TERMS AND AMOUNTS OF BBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) No Compen tion
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPEN ATION): No Compensation
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section -488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
❑ Yes ® No: 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 El 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 (1) 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 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, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B ILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERT
/lam% � :��
Sig - 'ure of Lobbyist
I do solemnly swear that all of the foregoing 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 C Code and ' J / irements.
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Signature of Lobbyist: -.—
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: I PRINCIPAL IDENTIFICATION: ,,,
o
O N / _ N 05
' LL (p (V - (p N
❑ Produced ID I Q o -. I 0 Produced ID
Form of Identification 3 to g L Form of Identification w
Q u 3k Q h io
y
Personally known (Lobbyist) a a w N IX Personally known (Principal) a a , x
`P'' _y
c a E E o a E E
VII. SIGNATURE AND STAMP OF NOTARY: 0 o a I o c
2 TU I ! C..1U
T
State of Florida, County of Miami -Dade I State of Florida, County of Miami -Dade
Sworn t9, d subscribe before me ,�0 �„ ` o -. worn n sub scri , - b ef.re me sm �� • »�o• -,
Th f .. day of i dtU171� ,2011 _� r►�,'� , 4 _ I his worn
of 1 , -
, 2011
"YO B,, S N(( O J iY�yU tP ,;:
Sign .tur f Publi Notary - State of Florida Signa re of ublic Note - State of Florida
Notarization of Lobbyist's si nature Notarzati of Principal's signature
TO BE COMPLETED BY CITY CLERK'S TAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ 4522 MCR # . L Date Paid (67:0A/
Lobbyist Registration Form received and verified by: ,
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc , ' i
Revised 1/11/2011
1
1
gA MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: v `` 6 1\9-
I understand that no later than Fe. rua 28th of each ear, 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 =s.
1) Lobbyist Expenditure and 11 ompensation Form
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.
,,,,e,/, 4f8f
Signature: Date: