Jay Stein/Tudor South Beach Resort - No. Condo Association, Inc.m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means ail persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordnance, resolution, action or decision of any commissioner, any actlon, deasion, 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Stein Jay
BUSINESS NAME AND ADDRESS (Number and Street) (City} (State) (Zip Code)
Tudor South Beach Resort - North,Condominium Association, Inc.; 1119 Collins Ave., Miami Beach, FL.
33139
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(212) 474-9865 jstein@hh-r.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Tudor South Beach Resort -North Condominium Association, Inc.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1119 Collins Ave., Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(212) 474-9865 jstein@hh-r.com
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)J
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Jay Stein, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°~ OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:. NIA
ll. sPECIi=iC LoBBY ISSUE: Historic Preservation Board and Board of Adjustment applications
regarding certificates of appropriateness and variances in connection with renovations for 1111
and 1119 Collins Avenue (a.k.a., the Tudor and Palmer House hotels)
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of individuaUTitle B) Any Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards ~ ~ None
Cit Committees
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Requtred)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Requtred) No Special Compensation
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 Q No: Are you lobbying on a present or pending bid for goods. equipment or services. or on a present or pending
award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
^ Yes C! No: Are you lobbying on a pending application for a Development Agreement with the Ciri 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 only appears as a representative of snot-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.. .
H Yes O No: Are you representing anot-for-profit corporation or entity without special compensation or re)mbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1'~ 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 BE FILED EVEN IF THERE HAVE
BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOQ.•.
~~gnaRure ofL~bbyiet-~ "
I do solemnly swear that ali of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-4~2,~f the W]jafni~ch City Code and ali reporting requirements.
Signature of
Signature of Principal/C~ftt:~/
VI . LOBBYIST IDENTIFICA
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
ti ~eu~~n~f y known (Lobbyist) ,~{ ~~j~
..~~~
Notary Pubr~.- :ate or New York
No.~4Att60~(46>~TURE AND STAMP OF NOTARY:
Commission Expires March 20, l0
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of 1'N~^- , 200`1
:~' ~"
Signature of Publt Notary -State of Florida
Notarization of Lobbyist's signature
Produced ID
Form of Identification
Personally known (Principal) ~ S'l~i ~
MUNIR ARMED
State of Florida, County cl9'Rh>~dr~ti~'$d~ State of New York
o. 1AH6038953
Sworn to and subscribed ~,(~g;on EEx es March 20,10
This ~_ day of ~_, 20~
\ l~W ~~ -
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CL RK'S USE LY _
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~ MCR # ~ Date Paid
Lobbyist Registration Form received and verified by.
Revised 12!08/04
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