Russell W. Galbut/Mondrian South Beach 1100 West PropertiesMI~,NIIBEACH
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, deasion 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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
G~ t .~-~ ~r t- ~ ~~ s s ~ I ! 1~~~
OF
I. LOBBYIST RETAINED BY:
r ~L~L~ ~'~;~ ~~- ~tlL rc'rt~i ~S ~~..~~~. I I OLD 1'~~5+~v ~~ ,~lirfithi ~'c1C~,_,E'L
NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (7.ip Code)
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umber and Street) (City)
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FAX NUMBER:
1'~ct cLC+f ~SCFII~~t~~•~.C.~i-rY)
EMAIL:
out this section if principal is a Corporation, Partnership or Trust [Sectli-on 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~} h i E~ r l G~ yy~ ~j a 1 ~jt-~+-'
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% O++R MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~~ ~ r ct ~`ct C h vv~ p N f~
II. SPECIFIC LOBBY ISSUE: 1._,_
(v~ 1 5 C E' ~ ~ ~ ~ ~. c=~ ~„ ~ ~ 1'H ~ ~ 1 t f 1'l~( .1:~ SC'C~S ~l~ G r~ C~ f ~ Cl ~'1 ~ ~S
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
3:3 i3 ~
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
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By BY
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required)
t.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). N ~ N ~
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":
o Yes ia'No• Are you lobbvina on a present or pending bid for aoods eauipment or services. or on a
present or pending award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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~LENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITUR~S,Cf~ j~NSAT;ON~D~I~j~HE
REPORTING PERIOD. > ~~' ~~~
r% Signa`fure of Lobbyi
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I do solemnly swear that all of the 1
familiar with the provisions contained
requirements.
facts are true and correct and that I have read or am
~ 2-482 of the Miami Beach City Code and all reporting
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
n Produced ID
Form of Identification
~VOTgRy
;•y= C•-U~A ~ OP ~~~
~m~t 'I'~n~.'
80!ypEU r7iR~~, A ~#DD$&4`¢S9
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn o and subscrib d before me
This '8'~ da of ~ , 20 ~~
Sig re of Public Nota State of Florida
Notarization of Lobbyis-t's signature
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
Swann and rida, Coe before) me Dade 'a.tirtcBO,;br~4~~2p1d
Thi day of 2fA~
Sig ture of Pu i o - e ~1T da --
No 'zation of cipa gnature
FOR CLERK S~1rSE ONLY ~j U 7 1 ,
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # ~ I ~ / ~ Dates Paid -% s D cT
Lobbyist Registration Form received and verified by: ~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ~2 Revised 12/08/04
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..
Page 1 of 1
Prieto, Silvia
From: Dawn Tamayo [rwgassistant@crescentheights.com]
Sent: Tuesday, March 11, 2008 10:58 AM
To: Prieto, Silvia
Subject: Lobbyist registration form -disclosure
Silvia:
Russell Galbut is representing Mondrian as a lobbyist free of charge.
Dawn Tamayo
assistant to Rlassell Galbut
Crescent Heights cif America., Inc..
2'?C?0 BiSCavne Rhd.
Mi~tm3, FL 331:3 i
Tel: (305) 374-571.)0 f~Xt. 7282
laa~: (307) 573-8~8~a
rnailto: nz~gassisianta~~rescertih.c~ights.cvrr
www. crescer_tth~u7~t.t~. scant.
03/11/2008