Suzan Jacobs/Star Island Entertainment, LLC
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MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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 refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Jacobs
(Last)
Suzan
(First)
J.
(M.!)
Levine & Partners, PA, 1110 Brickell Avenue. Miami. FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
(305) 372-1350
TELEPHONE NUMBER:
(305) 372-1352
FAX NUMBER:
sii~levinplnwfirm r.am
EMAIL:
We Colline
NAME OF PRINCIPAL/CUENT:
f-tI\ ,o.nJ :7 ( &-j
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BUSINESS NAME AND ADDRESS
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LOBBYIST RETAINED BY: (2.,!:'~rt. _ Be --: l~ - ,~ & star IslarrlEl1t:ertairIren, ILC)*
l\Vc~ ~{__~(~J ~~~(/\4 L.LC
1~~;~~(M~~ FL
(Number and Street) (City) (State)
~Ce "1-Z~:b<-{ b
FAX NUMBER: (Optional) EMAIL: (Optional)
*star Island Entertainment ILC / Mansion 1235 Washin on Ave. Miarri. B:a:h, FL 33139
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
33139
(Zip Code)
I.
o
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: 1'2- ~ A-tJ~
II. SPECIFIC LOBBY ISSUE:
III.
CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
~
(~S
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
1\/. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$295.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
DYes
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~NO: Are YOU lobbyina on a Dendina aDDlication for a DeveloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use
MaD? '
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 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..
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER. OATH, LISTING LOBBYING EXPENDITU~. ES, \ AS }/\tELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED Nil CALENDlAR YEAR. A STATEMENT
~~~~~~:~:~N IF THERE HAVE BEEN NO EXPENDIT,Ui E., ,OR it;;,~SATION DURING THE
^IYhh, . rlt
}1iJ'1frJrrture of;t yist
" l tI
I do solemnly swear that all of the (to reg . g fa s are tfue and correct and that I have read or am
familiar with the provisions c9!ltained! in ion -482 of the Miami Beach City Code and all reporting
requirements. ' ' {/1
Signature of Lobbyist:
I
Signature of Principal/CIi~k
D Produced ID
~
VI.
o Produced ID
Form of Identific .
~ Personally ~.:: '" .. YIS GRACE RUFIN
, f*~"1'"b~ :.~ MY COMMISSION # DO 381867
VII. SIGNATU ~~S1AMPIIUB:IlI8lBiUI;2008
" "'~:P"'t~.. Bonded Thru NOllIry Public Underwrl1...
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State of Florida, Courit}i"'Of
S,.w, 0, rn t" ,"I'.',"bsc',;E~re me r.(iJ
Td~' ~ J:: Of, ~w
ISignature of Public Notary - State of Florida
, Notarization of Lobbyist's signature
Signature of blic Notary - State of Florida
Notarizatio of Principal's signature
, FOR CLERK'S USE ONLY
Annual Registration fee: VJ Yes [ ] No AmountPaid:2 s-.cx.: --,MCR #RB214
Lobbyist Registration Form received and verified by; \--A ~e 6
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM ~
Date Paid p-! (a kY 0
I ~
Revised 12/08/04
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