Raymond Fort - Marisa Galbut RECEIVED
• ,. DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
APR 04 2023
•
AIAMI BEACH CITY OF MIAMI BEACH
Office of the City Clerk OFFICE nr_ 1-LIE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
305.673.7411
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 City Code Chapter 2,Article VII, Division 3,entitled"Lobbyists,'
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a'separate sheet(s)of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Fort Raymond
NAME OF LOBBYIST (Last) (First) (Middle Name)
Arquitectonica 2900 Oak Avenue Miami Florida 33133
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 372-1812 rfort@arquitectonica.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Galbut Marisa
NAME OF PRINCIPAL (Last) (First) (Middle Name)
740 Alton Road,LLC 4770 Biscayne Blvd.,Suite 1100 Miami Florida 33137
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700 mgalbut@crescentheights.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
o Pursuant to GI Code Section 2 82(h)( )a,. r1 principal of a y corporation, partnership,or o her entity who appears as a lobbyis on behal of that
entity p••1.I Gott pensationEglignfunw4i,iad1{JIROarpea rice,c...1=kildigaill indirect,®?coningen,I'si1 or^ @Qci1?@j • t
an item shall repute with be Jerk as required b thi subsection but shall not be required to pay any registration fee
N
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): M. Galbut
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached.
Page 1 of 5DocVenfy
www docver�y comF220A-832D-47A3-92A2-A7907956A18D I __Page 8 of 35_I_8A7907956A18D-i liii .��''MI
III I
• DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Development Approvals &Permitting Issues,including but not limited to the Historic Preservation
Board,Design Review Board,Planning Board,Board of Adjustment,Land Use Development, City
Commission, and any City Workshops or Committees,if necessary,relating to the properties located
at 710-720-740 Alton Road in Miami Beach,Florida.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
Title of Person to be Lobbied
Staff for the Planning&Building Department None X
Public Works&City Administration,PB,HPB,BOA None X
DRB,City Commission, and Mayor as necessary None X
Land Use &Sustainability Committee 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.
ry List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
None
0
rn
n
0
rn
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
0
CON $ .00 per hour
LL
Page 2 of 5
I owocVerifywvw do er co3F220A-832D-47A3-92A2•A79W956A18D L page 9 of 35 _1_9A79W956A180 ( 1111
ism
III I
- , DocuSian Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes XNo: 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 City Code Section 2-490,entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
—Yes XNo: 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 City Code Section 2-482(h), any person (except those exempt from the definition of"lobbyist" as set forth in
Section 2-481)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 city clerk as required by this section,but shall not be required to pay any registration fees.
_Yes XNo: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific, technical or other specialized information or testimony in public meetings;any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes X No: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services
within the past election cycle.See Section 2-491 for more information.
—Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
_Yes X_No: If yes, has it been less than 12 months since the elected official(s)whom you provided campaign
consulting services was sworn im
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbying the City Commission at a public meeting.
M
_Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
0
0
v,
0
h
0
Yes X No: If yes, we,e you promised or did you receive economic consideration i_ exchange `-or campaign
— —
oonsulting serves
icr
Q
R TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
M
a Annual Registration fee:g g [ ]Yes[ ]No Amount Paid$ MCR#, Date Paid
0
N
in Lobbyist Registration Form received and verified by:
0 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018
,
ul
Page 3 of 5
DocVerify ID:
do er N corrF220A•832D-47A3-92A2-A7907958A18b 1 Page 10 of 35 I 10A7907956A18D� ,III Q37Zi� 1I III 1
•
• , DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
VI. SIGNATURES UNDER OATH:
ON. FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMP,EN IT OI iDURING THE REPORTING PERIOD.'
Signature of Lobbyist: Date ns/��/�n2s
9 Y . � e mizata, eoevez...
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Cod- j.': &11,3PtS ing requirements.
Signature of Lobbyist: nc12:•0cec402... DocuSigned by: Date -03/22/2023
A/LOYtSA, Uf
Signature of Principal: Date 03/22/2023
7FA87oo88Fe34A...
•
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
County Of: Miami-Dade County of: Miami-Dade
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of 0 physical presence by means of❑ physical presence
or El online notarization, or I online notarization,
this day of nznonmq , 20_, by this_day of n1/99/ n ,20_, by
Raymond Fort Marisa Galbut
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Kre -- _Personally Kno �-
0
N `9pr.ao � dW 5mdm�t.aW
Signature of Notary Public Signature of Notary Public
Diana Ramos Diana Ramos
o - -
Name of Notary, Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
/ Diana Ramos / (� Dana Ramos 4
Commission#GG 308355 ( Iommission#GG 308355
4 Notary Public-State of Florida I Notary Public-State of Florida
• 1 TIA i y Commission Expires Apr 10,2023 t•Ig persons: I oy Commission Expires Apr 10,2023
__:__.:._ `�°^'^�al or other specialize^��'° m�-_.__.___..:_ ___: y person who
O only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct,indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
• not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
LU
Page 4 of 5
Dwww doc er ID:
conF220A-832D-47A3-92A2-A7907956A18D r Page 11 of 35 T 11A7907956A18D
• , DocuSign Envelope ID`.DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
MIAMIBEACH
City of Miami Beach, t700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
•
Office of the City Clerk
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
NAME OF LOBBYIST: Raymond Fort
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 of each year, 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.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
co
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
Dea by:
03/22/2023
Aol2sLof 0000402...
Signature of Lobbyist Date
M
Qo F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20.REG.doc
cv
w
Page5of5
DocVerify ID:'I
www.do er comF220A-832D-47A3-92A2-A7907958A18D I Page 12 of 35 T 12A7907956A18D-_1 ,III EttralI III I
, DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in 740 Alton RD, LLC
Percentage Interest
Ronruss Nobe Creek, LLC 22.5%
Alton M and J Investments LLC 50.0%
Brack-Tel Alton, LLC 27.5%
Interests in Ronruss Nobe Creek, LLC
Percentage Interest
Ronruss Partners, Ltd. 100%
Interests in Ronruss Partners, Ltd.
•
Percentage Interest
Ronruss Corporation 1.0%
Russell Galbut 44.1%
Ronalee Galbut 44.1%
Marisa Galbut, LLLP 5.52%
Jenna Galbut, LLLP 5.28%
Interests in Ronruss Corporation
Percentage Interest
Russell Galbut 49.5%
Ronalee Galbut 49.5D/D
Abraham A. Galbut 1.0%
and Nancy K Galbut
O
Interests in Marisa Galbut, LLLP
of
Percentage Interest
Russell Galbut 1.0%
Marisa Galbut 99.0%
O
m
N
6
N
a,
W
N
LL
W
r DocVerify
eID: E3F220A-832D-47A3-92A2-A7907956A18D Page 13 of 35 13A7907956A16D i ,III i ERS1IIII I
a DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C
Interests in Jenna Galbut, LLLP
Percentage Interest
Russell Galbut 1.0%
Jenna Galbut 99.0%
Interests in Alton M and J Investments LLC
Percentage Interest
Marisa Galbut, LLLP 37.5%
Jenna Galbut, LLLP 37.5%
R & R Family Grandchildren's Investment Trust#1 25.0%
Interests in R.& R Family Grandchildren's Investment Trust#1
Percentage Interest
The Children born and yet to be born of 100%
Marisa A. Galbut, Jenna B. Galbut,
and Keith M. Menin.
Interests in Brack-Tel Alton, LLC
Percentage Interest
Jefferson Brackin 36.35%
Donald Wayne Brackin 36.35%
NKW-EBG Prop 1, LLC 27.3%
Interests in NKW-EBG Prop 1, LLC
Percentage Interest
Abraham A. Galbut& Nancy K. Galbut 33.3%
Eric Galbut & Sarit Galbut 33.3%
Daniel Galbut & Jillian Galbut 33.3%
q
0
q
0
O
0
W
DocVerify
www do IDy E3F220A-832D-47A3-92A2-A7907956A16D _ 14A7907956A18D Page 14 of 35
4 "t",V' fi"�,s ,.�,e .��ax.,� • `,3+,
"av dpi. 54
Fes.+r
x'r",
3' Y'„ K's
4 •:x, ;r
"rf \
a" z
x�vps
6
%';�:_.,. ▪ ,a;. 'fir. ='��] �::�a°.", � F
*,.„:, -,,▪ ' ;;-1 C.. .,r-, a 7t�;;£» :,.. n,,
n, — . n r, o,; ?-� n.Y _''r Cit Hall
'-:a ,.,,, ;,, ,-4,,7",` % Z�'---r-,".-' .'p"-.#U',"ed,. .ate.>rQ; a,;; .:'"..i <a. -2 Y
V. , 'a,. ca. a:" y'h,
�;�;, rig! �,�; -raz� ,�=»`,�`, �a.F; -� .m, ,,�., .n. ;u�Y �T��<.,, Convention Center r.
,
,rx>.�r,,, 305-673-7420
�„ ��., ,�. o�= n �4�'? fix; ,,, �� a�. ;'�— Reach , FL 33139
�, '.r ��:� z F9!- `,t„f• f Z' �;,..;. � „rS tv`y`fur,�,f• D•s `ante,k•::"`.;'R .s
" .,. • °T;r "° ,; • `"r' s,, tea-�` ity ;,',a°`-».`;;'
10-01-0401110-050P
"? > '^:G} „�'•,=f ,, ,•;..� s. O;..'y�., ,-,,x., .fD *'*.a"`r,`�+;':E
29
'sr �`' ,y�> s", \'_ -t,.,ro,r�;h. �, Welcome
,, .�. • ;j" :��q=:,-��?, ▪ ';:" ,�.. <+i,. 5. -��_%;`_,+ r,.<,`,,,��,.yt>,,. tom::�,,.
�,.,> Asa ,��.. S2.Y ,,�, =#,tn=:;. ��
`� 40� 20
',Y • c�` 3 0
��` "w', ,,v� � 4 PM Car>.• ,. =a4 �*£ men V.
s
` r.
.. = ' < .
r'roS� rra'• ,'„ � .
w,>"rv.:ry a a
ii
F'R� ' y;a> ":r.��. y��, s, � • 70
4: • :`4i▪ "ii.::'"t ---'- 'Z,<, !r � � 'Z -?"
MISCE
LLANEOU
Sgy F.,,% 1• � �<' r� �eE � . � ,� .' „:, . , — ». Reference 1 M C R43[.
1434 x,; y+, V;s MCR OPEN MCR)
• . .. ,c�_ ma ' k : v\a ,a .° : :r. , = , � :: � � : `t:3:* .,.^;e # wz ,y:• a �< • C ';•; �;w , ey `j� ic %� :, �%u �� �:�:�= �"�xf. .��r�. �`w% � }�� T 2023 Item: MCR»4,- ti � �, 4 ; tyx �„ K� .:n„ ,`' i '� �� �° ' 16: ,,_.;t yG>q;mays. ,y "'ate, � � ,�ep. a, , ,, ` ;, '_ . y �. f , � °mow � �.1 t- ▪ t , a.' > @ $350.0000N C, - .ue ' • �Fyn a ' '�" w'= .,F � g »2, r ?." 5, � � . eF� x ```qY µs,�<�"�.h,. S+ .,,,,IA; .ja0 0 w�s,, sw`,�,„l, �a .v %7 �� '[^\4 V . i J`. r : ��:0 55 � f' , � �7�:x,yAg.a„
MCR
R) $350.00
5.
•
0,10
$350.00
o '�'.ti e " `,.-«,,u p`A tf'n"▪ tse' •�
rSn=
-
r.; „ ' , r� a
v' ,;-,
.00
350` Gubtatal.� r:,, �v. • >» $350.00
;. ,a max Ni--':::„ ma., � m„a s 4z ,� �yv " ' ,t; � �s="tazd „ ,a ° �1x yam"=v --� % �_ ��, �";,C>,• ., -
'' �▪>aV"~rE r▪r. . ' -�� ,.,. ti, x v ed' , :;+,
.,
'' y
1s�• v`
<t.
L
`
CHECK
• tJ.*rn��^▪ ,- '� - Yv t3�r �€'ri—G, �:-., . ', y3?�. \ 0..,r.,,5,e°„ - / , ,,a+, � y . .�,.@;�e,"x ,,v:,,'' ,.6�? ;,9 s��, e - '',m„ e i;;n.'.r�. r �sr y `" >x,,,y . `X sH 's • ,, . '> e .>a � Check $350.00
t k N u mbe ro o1208.0` "�??�.: iJ����• �wiu _ � - �:; ,y;�. ,\. ;,�= v-" nE }. ,p,:, 'i�>7r, . �y,�, �� , , .• I, � �
0.00
P4.07
4,1
$� \ : e ' it"`" Chan a due> " " >:: 'i :'' a3'3'? xS f iJ ' v1', -;�s^�f� . ,� .'. 0 t:li `c'Oz\ s-w'"h3%�;r .;' , " 2`sA,h\e�/ i>` a. '� , C:' :", Viz" `` r:� �<� o�- „ ��� Paid by; SMK ASSET MANAGEMENT LLC�n a 1:� ▪ Y '' " <� � *; > �' m , " 7 ,„i n~ {. �t'-.,� �1s. ��, , g, wv. ,,„ � "'=0� �,lr x�. �;� ° 5,N 0.", .rr3., ' ^ am \� , , . ` �.,�.,<,4,%'4,r,�'h; _ "'� � „,✓rr:r ▪. ' °- �� s� � �<�;�. ,f>a,;: x:: . ma % � "�:� . �>m��ti�1 z?i�. '�' -..;ram`s� '\ ,.,%`ti ,�.a ,,tr . r{"� ,.y"aa:„�� F «p�' ," ( `�? ; � �G:;�r � I :; ,I��., !. .>,,r ,;yl ...1`, "�'''w .• �\� I IIIIIIIIIII IIIIII IIII`-,,;",r,-^ � .�. &4... ;', :,.` n %te , .' :: ,r . , �, -...} SC a ' ,qe c. r `� %' =; �=��W _���, e ' �d`� II iter.,, �� �: : �� �� ▪ , f,-.. x..�,� ��h' r:� - .=�y� _� �: u�� ..a>r14 „ ..... no
, >. ,
{ ;: :.ram"` F
-y�,za la's :x� `, a„c.-"'�`� MI
,.,\ati`^ .y„ 'i: ;..'. {� ,Cry' - .: „2. raw to
,..1i'.,r :#a 5:, .'3', ;Y,"" 'tj43, 4.3#i•„Yu;.",< C.
rs
try` • ,,,\�Ay.
t ",k.
ii=a, ",a',
zrF"'�
r1 V I�y I DIN SIN iVil,
• ati t „4
ter;
� .s`�r
Q
,�r 3 41.fi�` "a
[.
5 • ,, .- -5- M' 5" �';e` ? ,>fi r,a;_.
• a �"c • -'=ems`'`tie ;\,n, ▪ 'ram - a�� 'i "*r,'» !
;:v�u ,`3?e .f�.� � <^n',`",�ra, -7-.fe LtOr *a;� ,, s;�s�. ,.,g�. ','s?,,-e;:'i•` "'&=1. z'..:. -
�;%,5� ,,.,,�."". ' '� ';';'` .' S,r!a�u> _._"' J"e..;: •:T-,,w'r• we.irrr',=••a-
'�a, ��.04 'i",uar„` `s% ;j a,,'"x.`^'d„- ,�ti.' g;;r.,.,. "`xa,;, __��.__._.._� _._ s:d•:",.ro••
9. `4 ^-bi.Ty, : ,.. .' Hi'.cd.4'r u1",; - /%o s?'�='.'- e �,n,': aY ...._._..�.-. .._ ._ _.
- =nr. `•>---„,„, .;` w "may.'-ter , 'a t;,.:, ,F,.�,,,3.Y �' .: '�9,..f`. .''/tea.-: __.,i
,'\ :s,'_.n�` a%fA„> ,,a�c,,,:�-. , y�F �<�;�•^..':�.a`3a�ar*.n.� ';Y
�. �:��,W\�.�= .:r�� .,� ..>. " ..v;am,,..,._..-<.�ar, ,,. ..,.y';.:-���.:. a",:�'s;:"�'z<�,«�-�.ca."a">:.a.�`{ a...�^ �„,�*, .. ,a
Thank you for your payment
CUSTOMER COPY