2024 Lobbyist Registration Form - 34 Star Island DR (Anthony Hsieh) " ,� S-Yc,c-ZsJo,n�.
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� MIAMIBEACH ot�ceottheciryc�erk �E� 1 ,� �024
1700 Convention Center Drive
Miami 8each, FL 33139
305.673.7471 � `" � "� '.:H�:N
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employetl or retaine4 whether paid or wt, by a pnricipal wM seeks to encourage Ne passage, defeat or
motlificafion of any oMinarice, rewlutioq edion or deasion of eny commissiorrer, any aclion, Aecision, rewmmendeUon of ihe City
Manager or any City board or canmittee;or any aqion,tlecision or recommenaatlon o/any Cdy personnel dutlng[he time petlotl of ihe
entire tlecision-makirg process an such adion, decision or recommentletion that foreseeaby will he heard or reviewed by the City
Commission, or e City boartl w commlltee. The teim specificaily inGudes the prindpal as well as any employee engagetl in lobbying
acGvi6es. The term"LobbyisP has speafic ezclusions. Pleasa refer M City Code CM1apter 2, Aiticle VII, Division 3,entitled 'Lobbylsts,"
for additional information.
InaWellone: Please complete all sections of ihis fortn and submit the wmpleted form,wilh ihe appliceble fee,to Ne Olfice of ihe City
Clerk. I/you need more space W canplete an answer, use a Separete sheet(s) of paper. If you have rwthing to repart in a particular
section, you must wnte 'none or 'Na' in that section. Any change to eny in/ormation originally filad, or any atldilional Ciry
Commissioner or personnel w�o are also sought to be bbbietl shall require ihet Ne lobbylst file an amendmen[to the registration fortn.
The 1o66yist has a conlinuing tluty to supply information anG ertrentl the fartns filed thmughout tha panod that ihe lobbying occurs.
Separate registration forms shall Oe required for each pnndpal reprecented on each spedf�c issue.
I. LOBBYIST INFORMATION:
Slavens T��
NAME OF LOBBYIST (Last) (First) (MitlAk Name)
LSN Law, P.A. 3800 NE 7 st Avenue Suite 200 Miami FI 33137
IOBBVIST BUSINESS NAME ANO ADDRESS (Number erd Street) (City) (Slate) (Zip Cotle)
305-673-2528 tslavens@Isnlaw.com
LOBBVISTBUSINESSTELEPHONENUMBER CELLULARTELEPHONENUMBER EMAILADDRESS
II. PRINCIPAL INFORMATION:
Hsieh Anthony
NAME OF PRINCIPAL (Laat) (firet) (Middk Neme)
JLSA Star LLC 34 Star Island Drive Miami Beach FL 33139
PRiNCIPAL BUSINESS NAME AND ADORE55 (Number end Street) (Cdy) (Shte) (Zip Cotle)
617-710-7023 mauricegriotlic�gmail.com
PRINCIPALBUSINESSTELEPHONENUMBER CELLUTARTELEPHONENUMBER EMAILADORE55
PursueM to Ciry Catle Section 2�182(A)(1�(a): A principel of any wrporelbn, paMenhip, or dher en[ity who appeen ee e lobbybl on behelf M thel
enMy,withoul apeGal canpensetlon or reimbunemeM br the eppea'ence,whethe�OireG,intlirect,or continpen[,W ezprase suppoM1 af w appoal'an to
en ilem shell reputer with ihe CbM as requiretl by Nu subseGion bul ahall ial be required to pay any repuUation faes.
If tho principal is a Corpontion, Partnership or Truat, !he followiny information MUST be provided
pursuant to City Code Sectfon 2-482�¢):
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(i/nona,wr10elUA): A�thOfly HSI@h (S01@ Mertlbef)
. NAME OF ALL PERSONS HOLDINO,DIRECTLY OR INDIRECTLV,A 6%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERBHIP OR TRUST�H noire,wrib N/A�: '4nthOny HSiBh (Sol6 Mef11b0f)
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III. ISSUE TO BE LOBBIED:
Describe with as much delail as is praetical, including but not Iimitetl!o a specific descrlptlon where
applicable of a pending request tor proposal, invifadon to bid, or public hearing number.
Development approvals & permitting issues, including, but not limited to Members of the City Administration,
Members of City Staff and Members of HPB, PB, DRB, and BOA, City Commission and Mayor, relating to
The property located at 34 Star Island Drive, fle number DRB23-0983.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code SecSion 2y182(aH4�, IfsS the City Commlasbner or City personnel souqht to be
lobbied, and whether the lobbyist has entered into any conlraeSual relalionship (paid or unpaid) with
sald City Commissioner or City personnel from 12 mo�ths precedinp such commencemen! oT service
with the City to the present date, sWdng the general nature oi the subjeot conlraelual reladonship.
Full Name of Individual and Contraetual Rslallonship(If yes,explain) YES NO
TIGe M Person!o be Lobbled
Members of City Administration and Members of Ci Staff X
Members of Historic Preservation Board (HPB) X
Planning Board (PB), Design Review Board (DRB) X
Board of Adjustment (BOA), City Commission and a or X
Pursuan! W City Code SecUon 2-482�g�, every registrant shall be required to slate the erzten! oi any
business, financial, familial or professional relatlonship, or oSher relatlonship giving rise to an
appearance oi an impropriety, wiSh any current City Commissioner or City personnel who is sought to
bs lobbied as identitletl on !he iobbyist registradon form flled.
List any Business, Finaneial, Familial or Pro/essional Reladonshlp, or olhsr relationship piving risa to an
a aronea ot im ro rie if none writa N/A :
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Soecific. (Note that a
contingsn�y foe is prohibited pursuant W Ciry Code Sec. 2-485.3�:
$950 hr
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The following six(6)quesdons MUST be answerW:
i) PursuaM[a City Code Section 2J88,entitletl"Pro�ibded Campaign Conlributions By Lo6byisls On Procuremm�Issues°:
_YeaXNo: Are vou Iobbvina on a orecan!or oerMlna bid br aoods. wulomeM or aervleea. or on a orasent or
pan0lna award(or aooEs,eauloment or servleeT
2) Pursuant to City Code Seclion 2�480, eniNed"Prohi6ited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_Yes�ilo: qre vou Iobbvina on a uendina aonllcatlon br a Develooment AareemeM with Ne CIN or aoollaatlon
for¢h nl I r h ' F tl
3) Pursuant to City Code SecUon 2-484(h), any person (excepl ihose exempt from ihe definition of "IobbyisT as set forth in
Section 2-487)who only eppears as a representative of a not-For-profit corpora6on or enGty withoul spedal compensation or
reimbursement tor the appearanca,whether direct or indirecl to express support o/or opposition to any item,shall tegister with
the dty clerk as required by ihis section,but shall not be required to pay any registration fees.
_Veq�No: Am vou renreseMlna a nobtor-orofl! corooraUon or entlN wlMout awalal comoensatlon or
relmbureamantT
4) Pursuantto CiTy Code Section 2-487, the tertn "IobbyisP sped(cally exGudes the following persons: Expert wdnesses who
provide onry scienpfic,technical or other speual¢etl intortnation or testimony in public meefings;any person who only appears
as a representative of a neighborhoo0 association without compensation or reimbursemeM tor the appearance,whether direct,
indirect or contingent,to express support ot or opposiNon to any item;antl eny person who only appeare as a representative of
nohfor-pro(t community based organizefion /or the purpose of requesting a grent without special compensation w
reimbursement fo�ihe appearance.
_Yes�lo: Am vou orovltlina onlv xleMlflo. Uchnlcal or other soeciallzetl Informatlon: aoosarim as a
rooreseMative ot a nelahborhootl assoelatlon wHhou! soeelal eanosnsatlon or relmbuisemeM or
rooreaentlno a nobforgroflt bacetl oraanizatlon for the ourooae of reauestlna a anM wlMout
aeeclal comoensatlon or relmbursement?
5) Pursuant[o Ciry CoAe Section 2�91�7), no campaign consNtant shall lobby lhe City Commission for a period of 12 monihs
follovnng the swearing in of any electetl official(s)for whom the campaign consuNant providetl campalgn consulting services
wdhin the past election cycle. See Section 2-491 (or more in(ormatlon.
_Vss�(lo: Hove vou orovided eamwlan eonsukina sorvleoa!o an Ineumbent membar of Me CIN Commlaslon
wifhin the wet eleetlon evele4 H ves. oleaea Iis!the Ineumbent memWAsl of the CIN Commission:
_Ya3�No: If ves. has It been lass than 72 moMhs since tlu elsatad oMclalfsl whom vou orovldsd aamoalon
eoireuNina sarviws was sworn In?
6) Pursuant to Ctty Code Section 2-�82�a��6�a., a lobbyist who has within the past election ryGe provided campagn conwlting
services to an incumbent member o(the City Commission(which lobbyirg adiviry is not othe�wise prohibRetl Ey Cotle section
2-491) shall disdose such paRiwlar service on his/her lobbyist registretion form antl shall oralN disclose such oerticular
i beTor obb b C C ' io t ic m C
_Ves�io: Have vou orovlAetl eamoalan eonsuWna servlees W an innumbsnt mambsr o!ihe CIN Commisalon
yAMin Me oast eleetlon evele?If ves.oluss Iiat the ineum Wnt memberlsl of tM CIN Commlaslon:
_Yes�lo: 1! vas. wen vou oromisetl or dltl vou ncelve economle conslderotlon in exehanaa far wmwian
conaulflno servlcas7
TO BE COMPLETEO BY CITY CLERK'S ST�PF ONIY
Ye:b AnnVa� on /e-�• 3
Annu�l Rpie4atlen ha: I 1 Yn Ne Amew�l PaW S'3So MCR r�33o-2 S O�Ee P�id� �J3 '�
Lobbylst RpisVadon Porm r�wiwtl�ntl verlfiM by:�
F:\CLER\SALL\aFORMS\�088YISTFORMS\LobbyisiRegishatianFormRerlsed0]-11-20REG.tlac RCYIld03/Il/311=0
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH VEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBVIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR CO ENSATI FIOU ING THE REPORTING PERIOD.' n n
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Signature of LobbyisC Date
I do solemnly swear or affrm that al of the foregoing facts. statements, and disdosures in this form are true and correct,
and that I have read or am famili with [he provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists° of
the Miami Beach City C�oJ��/(��/a��ll reporti airements. �`� 1��
Signature of LobbyisC �/ VVI�/ Date
Signature of Princlpal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of �� State of
County of: � � ' f 1 County of:
Swom to (or affirmed)and subscribed before me, Swom to(or aifirmed)and subscribed before me,
by means of O physical resence by means of� physical presence
or 0 o�7I�ne notarizati /�I1 or 0 online no[arizatioq
this �6 day of 20� by Ihis_day of 20_, by
Tracy Slavens Anthony Hsieh
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFlCATION FORM OF I�ENTIRGATION
_Pe so a ly I nown _Personally Known
Signa ur Notary Pu lic Signature of Notary Public
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Name of No ary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) �� (NOTARY SEAL)
LlIBE711 BUENO
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F%PNtES:M�andx 12,T0Y1
'The term"IabbyiSP'speci
Expert wilnesses who provitle only scientifq technical or other specialized information or�estimony in public meetings', any person who
onty appeare as a representative of a neighborhood association withoul compensation or reimbursement for�he appearance, whether
direct, indirec� or contingent, �o express support of or opposilion to any ilem; antl any person who only appears as a representative of
nobfor-profit communiry based organization for the purpose o�requesting a grant wilhout special compensation or reimbursement for
the appearance.
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH 1O88Y1ST SHALI SUBMI7 TO THE OFFICE OF THE CITY CLERK A
SIONED STATEMENT UNDER OATH. LI&TIN6 LOBBYIN6 EYaENDITLwon, pg yyci � en rtniueeuaaT�nu
RECEIVED FOR THE PRECEDING CALENOAR YEAR WITH REOAR� TO 7NE SPEGIFIC 198U� ON NMICH T41P
LOBBYIS7 HAS BEEN ENOAOED TO LOBBY A 8TA7EMENT SHALL BE FILEO EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTIN6 PERIOD'
Signature of Lobbylst: Date
I do sWemnly swear or alfirm Mat all of the fore9oin01acts, statements, and disclosurcs In this form are true antl correct,
and that I have reatl or am faml�lar wiU the provisions conqinetl In Chapter 2, Art. VII, Division 3, entitletl "LobbyisGs" ot
tha Miami Beac� Ciry Cotle antl all reporting requirements.
Sipneture of Lobbyist Date /
Signature of PrincipaC �� Date Z (s� z U
VII. NOTARY SIGNATURE AND SEAI.:
LOBBYIST: PRINCIPAL /� �(�
Sqteof Stateof ���(�_�n9`p��nJnF1 �p
counry oC counry oi: 1 Y\�lYi 1\� '� }t
SWorn M(or aKrmetl)antl subscribed before me, Swom to(or aKrmed)antl subscnbetl before me,
by means of�physical presence by means of[� physiwl presence
or�online notarization, or O online notariz �I
this_day of 20_,by this�tlay of 202 by
Tracy Slavens Anthony Hsieh
NAME OF LOBBYIST NqME OF PRINCIPNL
Pmtlucetl ID Protlucetl ID
FORM OF IDEMIFICPTION � F M OF IOENTIFICATION
_Personally Known _Pars n
�
Slgnature W Notary Public SlgnaNre o ry Pu1,�Iic
�1 1�1 �1J
Name of Notary, Typed, Printed or Stamped Name W Notary, Typed, Printed or Stamped
(NOTARY SEAL) (NOTARY SEAL)
t�'�?�� 1II9E7NBUENo
t•: : MYCOIIY16910N�HH378SM
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'The term"Iobbyisl"specifcally excludes tha toXowing parsona:
Expetl witnessas who provide only scieMNk,techMcal w other special¢etl information or�esdmony in publk meetings;any person w�o
only appears as a representallve of e neighborhaod asnwlafion withoul wmpensetion or relmbursemem for lhe appearance,whether
direct, intliract or contlngent,lo express support of w opposiFon to any item',antl a'ry person who only eppeare es a rapresenlatNe of
nol-Por-profll communily pesetl organization for ihe purpose of requesling a grant without spacial campansaHon or reimbursement far
Ne appearerree.
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nni ,�,MIBEA,c �
Ciry ol Miami eeoah, V00 Convemion Cemer Drive,Mioml Beach,Flarida 33139,www.miomlbeachll.gov
Office o(ihe Ciy Clark
Rafael E. Gronado, City Clerk CityClerk@miomibeachfl.gov
Tel� 305.673.7411, Fax: 305.673.7254
NAME OF LOBBYIST: Tracy Slavens
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notiTy any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penallies that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements fled after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to fle the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30'^ of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specifc issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Offce of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
00.00 ursu S tion 2-482 of the Miami Beach City Code.
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Signature of Lo yi t Date
F.�GtER\$PLUeFOPMbILOBBV15T FORMSVLn��y¢I Regi9re�ion Fa.'m RniSe] 09-1 RO FEGOoc
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Miscellaneous Cash Receipt -
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Miscellaneous-MCR-2024
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