Jay Stein/Tudor So Beach Resort Condo Assoc.
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 ~ c °~~
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LOBBYIST REGISTRATION FORM ~. Mty`-~
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encoU~age Jl~ ~c!
passage, defeat or modification of any ordinance, resolution, action or decision bf any commissioner; afiy~ actin, . ~ t
decision, recommendation of the City Manager or any city board or committee; or any action, de~ion ~
recommendation of any city personnel during the time period of the entire decision-making process on sucfit-actirnl `-~
decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city~pnd
committee. The term specifically includes the principal as well as any employee engaged in lobbying activitie'. T e
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.1.)
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 NJA jstein@hh-r.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Tudor South Beach Resort 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 l 111 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 IndividuallTitle B An Financial, Familial or Professional Relationshi
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) PRIN_CIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
Required). No special compensation (lobbyist is an employee of the Principa
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":
~lYes 6a No• Are you lobbxing on a present or pending bid for goods eauipment or serv_ ices, 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":
^Yes ~ No• Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the Citv'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 ~ No• Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
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 CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
Signature
I do solemnly swear that all of the foregoin cts a true a correct and that I have read or am familiar with the
provisions contained in Section 2-482 of i Be h City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST I
^ Produced ID
Form of Identification
[~, Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
[~ Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me M U N I R A H M E L$worn to and subscribed before me
This 2day of SpN~ , 2008 Notary Public State of Naw~'b16k?-day of S~ N E , 2008 t~ i R A H N E C?
No. OtAH0if38953 '~'C~'~~~^ y Public State s1 New Yc r,
r0icsion Expires Marctt 20,1 ~ No. OtAH66''311953
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Signature of Public otary -State of Florida Signature of ublic Notary -State of I~~~' Expires #Aarcn ~0,to
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ON Y
Annual Registration fee: [)Yes [ ] No Amount Paid S MCR # S ate Paid
Lobbyist Registration Form received and verified by:
F•\CLER\LOBBYIS11Lobbyist Registration Form 32708.doc Revise 03/27!2008
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m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.QOv
CITY CLERK office CityClerkCa~miamibeachfl aov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Jay Stein
I understand that no later than October 15t of each vear, 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, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
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Signature Date:
MIADOCS 35465251
Ownership Interest in Tudor South Beach Resort Condominium Association, Inc.
Because the Tudor South Beach Resort 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.
MIADOCS 3547845 1