Jay Stein/TBS Realty Tudor South Beachm 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 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.
Stein Jay
NAME OF LOBBYIST: (Last) (First) (M.I.)
200 West 55`h Street, Suite 42 New York, N.Y. 10019
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 474-9865 N/A jstein hh-r.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
TBS Realty, LLC; Tudor South Beach Resort Condominium, Inc.; and Tudor South Beach Resort-North
Condominium, Inc.
NAME OF PRINCIPAL/CLIENT:
1111 & 1119 Collins Avenue Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 474-9865 N/A jstein hh-r.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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 and Jay Stein
IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibit "A" attached.
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II. SPECIFIC LOBBY ISSUE: ~ ~ ~t
Conditional Use Permit r7 : cv ~+i
Issue to be lobbied (Describe in detail): - . 1
it
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g~+inc~e a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise ct~ an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Cod~,~ectieq 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
City of Miami Beach Planning Board None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No special compensation
B) PRINCIPAL'S 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 6~ No• Are you lobbvinq on a present or pending bid for goods eauipment 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 6Z1 No• Are you lobbvinq 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 snot-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:
Signature of Lobbyist:
Signature of Principal/Client: '° ~ ~~ti ~ - - ~'
Rabinder Pal Singh on behalf of TBS Realty, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
^ Produced ID
Form of Identification
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 21 day of -hy C~ , 2008
Signature of Public Notarypb~~~gfnF~og4~e of New York
Notarization of Lobbyist's signatwr®tAH6638953
Commission Expires Match 20,t1~
Form of Identification
[~ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of M1(r , 2008
` ~~~
AIIR AHMED
Signature o Public Notary - St~t;t~ ~ui~~ic state of New York
Notarization of Principal's signatu eNo. otAH8038s53
Commission Expires March 20 ~n
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIS11Lobbyist Registration Form 32708.doc Revised 03/27/2008
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~li_6n,~ch City Code and all reporting requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov
CITY CLERK office CityClerk .miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Jay Stein
I understand that no later than October 1g~ 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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Signat r e: Date:
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