Jay Stein/Tudor So Beach Resort-North Condo Assoc.~r,
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City of Miami Beach Office of the City Clerk '~ ~
1700 Convention Center Drive, Miami Beach, FL 33139 a' ; ~ s
LOBBYIST REGISTRATION FORM ~ti ~ ,~
Lobb ist means all ersons em to ed or retained whether aid or not, b a rinci al who seeks to en~eoura the:""'
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passage, defeat or modification of any ordinance, resolution, action or decision of any commissions ~~ny raOtion,
decision, recommendation of the City Manager or any city board or committee; or any action, decisS~ 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 bond 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)
200 West 55'h Street, Suite 42 New York, N.Y. 10019
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
(212) 474-9865 N/A jstein@hh-r.wm
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)
1111 & 1119 Collins Avenue Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(212) 474-9845 N/A jstein@hh-r.com
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• 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:
Please see attached
II. SPECIFIC LOBBY ISSUE:
Historic Preservation Board application regarding certificate of appropriateness in connection with 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: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual/Title B An Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No special compensation (lobbyist is an employee of the Principal)
_ B)_ ___ _ PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
--__-
(Required). No special compensation (lobbyist is an employee of the Principal)
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 6d 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":
QYes ~ No: Are you lobbying on a pending application for a Development Agreement with the Citv or
application for chance of zoning man designation or chance 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 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..
^Yes 6a No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client: ~
VI. LOBBYIST IDENTIFICA
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
^ Produced ID
Form of Identification
~. Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-DadeiLi ~ N 1 R A H M E D
Sworn to and subscribed before me Sworn to and subscribed before me
This 2dayof SV 6,2008 This 2-dayof ~il*~E,2008 Notary Public State of New York
_~ _ -~ N0. 07AH6038953
~;,. _ N I R A H M E D ./ Commissioe Expires March 2.0, jo
is State of New Y ~'-"'~~
Signature of Public Notary - Sta 9~l~rlt(d~ !~ nature of Public Notary -State of Florida
Notarization of Lobbyist's sign o. 01AH8088953 yotarization of Principal's si nature
L~i~ission Expires March 2"Q,]p g
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # S e Paid
Lobbyist Registration Form received and verifted by:
F:\CLER\LOBBYIS11Lobb ist Re istration Form 32708.doc Revised 03/27/2008
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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~f(ami B~echSity Code and all reporting requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CitvClerkCa~miamibeachfl.aov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Jay Stein
I understand that no later than October 1st of each year, I must file the following forms, 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 Form
2) Disclosure 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, 1 am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
Signature• Date:
MIADOCS 3547805 1
Ownership Interest in Tudor South Beach Resort-North Condominium Association, Inc.
Because the Tudor South Beach Resort-North Condominium Association, Inc. (the
"Association") is anot-for-profit condominium association, it has no shareholders or ownership
interests. All units are owned by TBS Realty, LLC. The President of the Association is Jay
Stein.
MLADOCS 3547852 1