Jay Stein/Tudor South Beach Resort - No. Condo Association, Inc. (2)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 commissioner; any action, decision, 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 prlndpal 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 Condominium Association, Inc.; 1111 Collins Ave., Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(212) 474-9865 ~ jstein@h~h-r.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
Tudor South Beach Resort Condominium Association, Inc.;
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1111 Collins Ave., Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional)
~ EMAIL: (Optional)
(212) 474-9865 jstein@hh-r.com •
FIII out this section if principal is a Corporation, PaRnership or Trust [SeeUon 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: NIA
II. SPECIFIC LOBBY ISSUE: ~ ~IIStOfIC PreSerVatlOn BOard and BOard Of AdjUStment applicatlOnS
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 IndlviduaUTitle 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: (Required) NO SpeClal COmpenSatlOn
B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION): (Required> 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 lobbvina on a present or pendina bid for goods. eauipment or services, or on a present or pending
award for aoods. eauipment or service?
2} Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Reat Estate
Development Issues":
^ Yes Q No: Are you lobbvina on a pendina application for a Development Agreement with the City or appUcation 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 a not-for-profit corporation or entity without specal
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, shat( not be required to pay any registration fees..
d Yes O No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1g' 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. /7 ,-~ _
I do solemnly swear that all of the foregoing facts are true and correct`and~f I have read or am familiar with the
Produced ID .
Form of Identification
M U N I R A Hl~;viplly known (Lobbyist) ~SJ)~p
Notary Public State of New York
No. ~)~H803~~ATURE AND STAMP OF NOTARY:
Commission xpires March 20, Ip
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~1 day of I~ ~' , 20~
~~~ ~~
Signature of blic Notary -State of Florida ,
Notarization of Lobbyist's signature
provisions contained in Section 2-48 f the M' i ch City Code and all porting requirements.
Signature of Lobbyist:
Signature of Principal/Cli
VI . LOBBYIST (DENT ICA tON: PRINCIPAL IDENTIFICATION:
FOR CLE K'S USE O Y
Annual Registration fee: Yes [ J No Amount Pa' MCR # V ' ~~ to Paid
Lobbyist Registration Form received and verified by:
Revised t 2/OSI04
Produced ID
Form of Identification
Personally known (Principal) ~pN S'f~i IJ
MUNIR AHMED
State of Florida, County of Miami-Da~~tary Public State of New York
Sworn to and subscribed before me No. 01 AH6038953
This_~dayof , i4~tr: C~an~sion Expires March 20,Iv
Signature of Public Notary -State of Florida
Notarization of Principal's signature
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