Alex Tachmes/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 includes the principal as well as any employee engaged in
lobbying activities. The term "Lobbyists" has specific exclusions. Please rater to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Tachmes Alexander I.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Shutts & Bowen LLP, 201 S. Biscayne Blvd., Suite 1500, Miami, FL 33131
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(305) 347-7341 (305) 347-7754 atachmes@shutts.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 (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 tssuE: 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/1'Itle 6) Any Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards None
Cit Committees
MIADOCS 2259001 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): '
Aj LOBBYIST DISCLOSURE: (Required) ~~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) ~/ f G/ ~ / ;
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":
Q Yes H No: Are you lobbying on a present or pending bid for goods equipment or services or on a present or bending
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 E] No: Are you lobbvino on a aendina application for a Development Agreement with the City 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 deflnitlon of "lobbyist" as set
forth in Section 2-481 above) who only appears as a representative of snot-for-profit corporation or entity without speaal
compensation or reimbursement for the appearance, whetherdirect, 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 anot-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH;
ON OCTOBER 1s1 EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, 1N 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 REPOR'GN1' PERIOD.
ignature of Lobbyist
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 2~4~?~ of the M~~rti ~asM.F'I~t Code and all reporting requirements.
Signature of
Signature of Principal/Client::
VI . LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION:
Produced ID i$ ~ Produced ID '
----.Fn[[rt of Identification
Personally known (Lobby) ~ ~ Form of Identification
~ ~C Personally known (Princi
al) 3-j~
~
. p
~,
VII SIGNATURE AND STAMP OF NOTARY:p~~• ~ ~. ~ M U N I R A H M E D
State of Florida, Count of Miami-Dade
y
rn ~~nd su
ed~re me
~
i .7 • • V]
~ ~'~ ^~-3 lic State of New York
~ ~ ~ ~ State of Florida, County of I~li~4fll~b~o~ 01AH6038953
~ ~ ~~ ~ Sworn to and subscribed befQr~mess~
~.,,,,ires March 20, ( O
, 200
This
day
of
._ g8
b p, o This -9_ day of ~t7'
S
~~lL 1
~~~~I C
C ~
n
N 00
~ .
.
(~
L J~G, (
r
p c=. \7J~
°
Signature of P biic Notary - fate of Florida ~ o o
, ~ y~ Signature of Public Notary State of Flori a
Notarization of Lobbyist's signature Notarization of Principal's signature
ERK'S USE ON Y
Annual Registration fee: [ J Yes (] No Amount Paid MCR Date Paid ~
Lobbyist Registration Form received and verified by.
Revised 12/08/04
MIADOCS 2259013 1