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Russell W. Galbut - Crescent Heights • v1/4- AA I AM! C '. A \ke. 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 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. Galbut Russell W NAME OF LOBBYIST: (Last) (First) (M.I) Crescent Heights 2200 Biscayne Blvd. Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Russell W Galbut NAME OF PRINCIPAL/CLIENT: Crescent Heights 2200 Biscayne Blvd. Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 rcialbut(c crescentheiahts.corn 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%0 MO E OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Development Board Approvals for 709 Alton Road, Miami Beach, Florida Issue to be lobbied(Describe in detail): nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(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 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 Staff, PB, HPB, BOA, DRB, Commission None X Pursuant to City Code Section 2-482(g)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 registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship NONE 61111Y C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 6 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 0 (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": _Yes X No: Are you lobbvina on a present or oendina bid for aoods.eauigment or services.or on a present or pending award for goods.eauigment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbying on a pendina application for a Development Agreement with the City or application for change of zonina map desianation or chanae to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (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 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 X No: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursement., V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR,C•u-_►. _ 1. .•i, D. •E : -•.:_ - iI•D .- ..- ‘ .‘;‘ " Signature of Lobbyist` t/�, 9 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 City Code and all reportin• .-• 're)..ents. Signature of Lobbyist:.∎ "e"..,. /� Signature of Principal/Client: 1 '' .��--� VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification V Personally known (Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, Cou ty of Miami-Dade State of Florida, C•unty of Miami-Dade Sworn • d subscri -d b i..----. "'--—0..^ —— + worn ._.• subscri ,ed before me Thi- ,�� day of�_'� , ,N�,'" .-0� his ��.�,� �y . .. . ....��, �. ..L� _ DAYAMI AGUIAR �. • •-� ..r.,,..:,41, _ Notary Public-State of Florida P, , � DAYAMI AGUIAR ). i ,o. 4:+ "v My Comm.Expires Mar 16,2015 I'�f►`•� .� , . r Public State of Florida �- �I T� ! ; - At , - toy Signature of 'u lic Nota phi S� „„�,,'F1'orldaCommission # EE 70292 9 Signat re oft •lic N. 7 4e f� .Expires Mar 16,2015 $ Notar atior of ••• _,... •-,T--.,,- .: +- . . Notari atio j. of P 'n '•r :tureCommission # EE 70292 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ No Amount Paid$ - . — MCR# 17/0/41 S' F y Date Paid Thij : Lobbyist Registration Form received and verified by: .. , .. , C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLF istration Form.doc Revised 04/27/2012 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov miamibeachfl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: Russell W Galbut I understand that no later than February 28 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 issues. 1) LOBBYIST EXPENDITURE AND COMPENSATION 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. //C2W/K Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in South Beach Heights II, LLC Percentage of Interest SBH Holdings II, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 SBH Management Company, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Holdings II, LLC Percentage of Interest CH Investment Holdings, LLC 89.89% 2200 Biscayne Blvd. Miami FL 33137 David Galbut and Gita Galbut 10.11% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Management Company, LLC Percentage of Interest CH Investment Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in CH Investment Holdings, LLC Percentage of Interest S Kahn CH Investments, LLLP 18.685% 2200 Biscayne Blvd. Miami FL 33137 S Kahn CH Holdings, LLLP 18.351% 2200 Biscayne Blvd. Miami FL 33137 Galbut CH Investments, LLLP 18.685% 2200 Biscayne Blvd. Miami FL 33137 Galbut CH Holdings, LLLP 18.351% 2200 Biscayne Blvd. Miami FL 33137 Menin CH-BT Co, LLLP 19.56% 2200 Biscayne Blvd. Miami FL 33137 Menin CH Holdings, LLLP 6.435% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Investments, LLLP Percentage of Interest S Kahn CH Investments 1, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 SK Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 • Interests in S Kahn CH Investments 1, LLC Percentage of Interest SK Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in SK Business Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Holdings, LLLP Percentage of Interest S Kahn CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Kahn 2009 Investments Irrevocable Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn Management, LLC Percentage of Interest Kahn Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Kahn Management Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Kahn 2009 Investments Irrevocable Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Investments, LLLP Percentage of Interest Galbut CH Investments 1, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 RF Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Investments 1, LLC Percentage of Interest RF Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in RF Business Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Holdings, LLLP Percentage of Interest Galbut CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Galbut 2009 Investments Irrevocable Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Management, LLC Percentage of Interest Galbut Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut Management Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut 2009 Investments Irrevocable Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH-BT Co., LLLP Percentage of Interest Menin CH-BT Co., LLC 1 2200 Biscayne Blvd. Miami FL 33137 Menin 1998 Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH-BT Co., LLC Percentage of Interest Menin 1998 Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin 1998 Business Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 , Interests in Menin CH Holdings, LLLP Percentage of Interest Menin CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Menin CH Holdings, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Management, LLC Percentage of Interest Menin Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin Management Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Holdings, LLC Percentage of Interest Menin 2009 Investments Irrevocable Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin 2009 Investments Irrevocable Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in KGM Equities, LLC Percentage of Interest Sonny Kahn 2004 Irrevocable Trust 37% 2200 Biscayne Blvd. Miami FL 33137 • Russell W. Galbut 2004 Irrevocable Trust 37% 2200 Biscayne Blvd. Miami FL 33137 Bruce A. Menin 2004 Irrevocable Trust 26% 2200 Biscayne Blvd. Miami FL 33137 Interests in Sonny Kahn 2004 Irrevocable Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Russell W. Galbut 2004 Irrevocable Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Bruce A. Menin 2004 Irrevocable Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 i }1 fir; T _ +� F f M a P City of Miami Beach-Florida h-Florida Finance Depa rtment 1 City Hall 150313-1 02/03/2015 6R1 1115 Tue eb 03,2015 01 :3BPM Trarts#3; 31 31 $350.00 MCRCLERK - f CR-Cit- Clerk MCR#: 401457 1 ITEM(S): TOTAL.; $350,00 Check (00061) MAID $350.00 Have a nice day! Miscellaneous Cash Receipt .: �{ -}��. .4 CITY OF MIAMI BEACH Y N No • D - ' Check O0 C0 $ El Cash Credit Card . 20 I r Received of . ../ve h// }C-C-.-7�^ f ez dy 3 �Address 1Z 0 x, E.' 1 i y' i f� 'rf l w GE P./ 3 ! For E 1 6�__ , -�.: � ` '� t7� t � r . (THIS INFORMATION MUST BE-COMPLETED) Office of Finance Director Account Number.. �; /' ¶ ' (//Y 'y VII - Pre Parer: f t:_, <:r Dept: ..., !",1 c. r