Jay Stein/TBS Realty, LLC
m MIAMIBEACH
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 commi;;sioner, any action, 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 inGudes the prinapal 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.L)
Stein Jay
BUSINESS NAME AND AOORESS (Number and Street) (City) (State) (Zip Code)
TBS Realty, LLC 200 West 55th Street, Suite 42, New York, NY 10019
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(212) 474-9865 jstein@hh-r.com
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
TBS Realty, LLC .
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
200 West 55th Street, Suite 42, New York , NY 10019
TELEPHONE NUMBER:
(212) 474-9865
FAX NUMBER: (Optional) EMAIL: (Optional)
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: Rabinder Pal Singh
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See Attached.
II. SPECIFIC 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 Individual/Title B) Any Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards None
Cit Committees
MIADOCS 2258490 1
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) Normal Compensation
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Regatred) Normal Compensation
The following information must be answered:
1) Pursuant to Miami Beach Clty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On
Procurement Issues":
O Yes E7 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": `
^ Yes ~ No: Are you lobbying on a pending application for a Development Agreement with the Citv or application for
change of zoning mad 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..
O Yes ®No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement.
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 PERIOD.
/~ /,9(gFSature of L~9kv~tist
I do solemnly swear that all of the foregoing facts are true and correct an that I have read or am familiar with the
provisions contained in Section 2-~},~2 of the~+liarty~each City Code and all reporting requirements.
Signature of
Signature of PrincipaUClien);./~
VI . LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced Ip
Form of Identification
M U N I R A H ~r~naily known (Lobbyist) 3~ ~~~
Notary Public State of New York
No. 01 MNI80389~GNATURE AND STAMP OF NOTARY:
Commission Expires March 20,10
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~_ day of ~cU(s- , 20Q~
~',~i~
Signature of Pu is Notary - State of Florida •
Notarization of Lobbyist's signature
Produced ID
Form of Identification
Personally known (Principal)
~IN~- Qom' sly ~v~=:~rr.IR AHMED
Notary Fublic State of New York
No. OtAH6036953
State of Florida, County of Miami-Dademmission Expires March 20,10
Sworn to and subscribed before me
This _~ day of /-il)G- , 20Q~
.~~.:~ i
Signature of Public Notary -State of Florida
Notarization of Principal's signature
OR CLERK'S USE ONLY
Annual Registration fee: es (] No Amount Pai ~ MCR # J1..1 ~Jle O ` Date Paid
Lobbyist Registration Form received and verified b P-~
Revised 12/08/04
MIADOCS 2258490 1
STRUCTURE CAART -DREAM SOUTH BBACH
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. ~. .. 1111-1119 Collins Avenue
• ~ , • 11~ami Beach, E+'L '•
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