Michael Isaac Jacobs - Qualifying Documents RECEIVED
APPOINTMENT OF CAMPAIGN TREASURER OFFICE OF THE CfTY CMK
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JAN 1 2 2024
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying CITY OF AVENTURA
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
(ZI Initial Filing of Form Re-filing to Change: [] Treasurer/Deputy Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
zw-OLS �L&tol;
4. Telephone 5. E-mail address
th. I Aff zw4um , ;VG S31 'BD
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
F1 my intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Write-In [] No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
w- S
11. Mailing Address 12. Telephone
2-0 b-1 t (C(V-( )
13. City 14. County l— 15. State 16. Zip Code 17 E-mail address
% 9 4,'/ e.6 M."13100 Oh LiLtiLz"_&L
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20. Address
L�L_ K4 q'117
21. City 22. County 23. State 24. Zip Code
4 =r L_ — t a u
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 26. Signature of Candidate
I/ 1),12oq X k_
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, lk�d--Acl llaf,*V) , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
I
V Date Signature of Campaign Trea urer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF RECEIVED
CANDIDATE OFFICE OF THE CITY CLERK
(Section 106.023, F.S.) JAN 1 2 2024
(Please print or type)
eiTy OF AVENTURA
candidate for the office of 61fi a-
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x L
Signature of Candidate Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05111)
ty of
i
x- ECEIVED
Municipalu ra
AvenL OFFICE OF THE CITY CLERK
2024 i
CITY OF AVENTURA
Access to the Candidate and CaMlDaianr
Handbook
and
The Election s of the StateFlorida
Candidate:
(Print Name)
Office Sought:
Commissioner Seat 1 [7�
Commissioner Seat 3 ❑
Commissioner Seat 5 ❑
I acknowledge that it is my responsibility to read, understand and follow the
requirements described in the City of Aventura Municipal Candidate Election
resources available on the City of Aventura Website ( .cityof v nt r .c ),
including but not limited to:
Candidate and Campaign Treasurer Handbook; Compilation of the Election Laws of the State of
Florida; City of Aventura Charter and Code of Ordinances; City of Aventura Political Sign Code;
List of City Vendors; Voter Registration Guide; Items for Sale from Miami-Dade County Elections
Department; Campaign Financing Forms; Frequently Asked Questions; and Common Reporting
Compliance Errors; as well as website links to the Miami-Dade County Elections Department and
State of Florida Division of Elections.
Acknowledged by:
Signature of Candidate
Date: i
Primary Telephone Number: G
Alternate Telephone Number: 2- t
E-mail address: #�� ,� i
PHONE: 305-466-8901 FAX: 305-466-8919
www.cityofaventura.com
. FV
= 5 m A e, rti
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Notice f CandidaLy
1, 3 key C1 a(0� 5 aersigne ;, an elector cat the City cat
ventura, who has resided continuously in the City for at least one (11 year preceding the state
of flU. .a" of this Notice of Candidacy, whose residence in the City o= Ave,ntura is
announce nay candidacy for the office of:
Commissioner Seat
Commissioner Seat
Commissioner Seat
Lo be voted d for at the elect°o? to b held on the $� day of Novembe,, 024, and hereby agree
LO se,ve :f ele cte i„
Signature of C;2nd'daO
Date and lour of tiling: �
Received '
City �`ierk,' u ervisor of iwle tion
OFFICE OF THE CITY CLERK
I'Cil -ode5er_. 6 1; AUG 12024
CANDIDATE OATH RECEIVED
NONPARTISAN OFFICE OFFICE OF THE CITY CLERK
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a write-in
candidate:
G 1 4 2024
Write-in candidate
OFFICE USE ONLY
0""ITY OF "ENTURA
Candidate 0.
Name to appear on ballot: M l a a d'( :Ta a.a G la t c4s
Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.)
Check box if name includes nickname_ ❑ (For use of a nickname,you must complete the Nickname Affidavit on reverse side.)
I swear or affirm that I am a candidate for the nonpartisan office of crl� (g'luNAI-3 J i o"-e/-
(Office) (District#)
I am a qualified elector of 411a- vl i County, Florida
(Circuit#) (Group or Seat#)
I am a qualified elector under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I
have qualified for no other public office in the state,the term of which office or any part thereof runs concurrent with the office I seek; and I
have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the
Constitution of the United States and the Constitution of the State of Florida.
Statement of Outstanding Fines, Fees, Or Penalties
I owe outstanding fines,fees,or penalties,that cumulatively exceed$250, for ethics or campaign finance violations(s. 99.021(1)(d),F.S.).
YES, I Do NO,I Do Not ✓
If you do,you must also specify the amount owed and each entity that levied the same on the reverse side.
h5 d OVA
Signature of Candidatb Telephone Number Email Address
�OV V N- f I fi P��c.� rok- L ?3( 8 D
Address of Legal Residence City State ZIP Code
STATE OF FLORIDA
COUNTY OF_t� l Signature of Notary Pu li
Sworn to (or affirmed)and subscribed before me by means of Print,Type,or Stamp Commissioned Name of Notary Public below:
online notarization ❑ OR physical presence
�m"�%
this day of 20 FEWSAL Tk
ION#NH364TOA
Personally Known I-I OR Produced Identification ❑ '''�oFF;o?�' EXPIRES: st17,2026
Type of Identification Produced:
DS-DE 302NP(Eff. 1012023) Rule 1S-2.0001, F.A.C.
Phonetic spelling for the audio ballot(not required for qualifying purposes): Print the name phonetically on the line below as you
wish it to be pronounced on the audio ballot as may be used by persons with disabilities(see instructions on page 3 of this form):
Statement o Qutstaning Fines, Fees or Fer�alfills
Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with no party affiliation, or a write-in
candidate,shall,at the time of subscribing to the oath or affirmation,state in writing whether he or she owes any outstanding fines,fees,
or penalties that cumulatively exceed$250 for any violations of s.8,Art. 11 of the State Constitution,the Code of Ethics for Public Officers
and Employees under part III of chapter 112,any local ethics ordinance governing standards of conduct and disclosure requirements,or
chapter 106.
�AC2�OFIt'It fi�fi#`
A�ida�ttfi �f�1ek��rte{f3nly r�giired if u�trtg nleknar�ie for fhe ballot)
My legal name is . I am over the age of eighteen (18)and the contents of this
affidavit are true and correct.
My nickname is . I am generally known by this nickname or have used it as part
of my legal name. I have not created the nickname to mislead voters. My nickname does not imply I am some other person,constitute
a political slogan or otherwise associate me with a cause or issue, or that is obscene or profane.
Signature of Candidate:
STATE OF FLORIDA
COUNTY OF
Signature of Notary Public
Sworn to(or affirmed)and subscribed before me by means Print,Type,or Stamp Commissioned Name of Notary Public below:
of online notarization ❑ OR physical presence ❑
this day of ,20
Personally Known ❑ OR Produced Identification ❑
Type of Identification Produced:
DS-DE 302NP(Eff. 1012023) Rule 1S-2.0001, F.A.C.
RECEIVED
DECLARATION AND FIRST AMENDMENTM- MOF THE CITY CLERK
FOR CANDIDATES Wl1O_kG1ZEE TO COMPUY WFrli
THE VOLL"N7ARY STATENIIENT OF FAIR CA)APAIGN PRACTICES
AUG 1 4 2024
VOLUNTARY STATEMENT OF FAIR CAMPAIGN PRACTICES
As a candidate for public office in fliami-Dade County, I believe that political issues cap. be freely debated without appealing to racial, ethnic,
religious, sexual, or other prejudices. 1 recognize that such negative appeals serve only to divide 'this c
and economic n-obl, CITY OFAVENTURA
T herJore,
1, 1 shall not make my race, religion, national origin, gender, physical disability, or sexual orientation an issue In my campaign.
2. 1 shall not make my opponent's race, religion, national origin, gender, physical disability, or sexual orientation an issue in my campaign.
3. 1 will condemn any appeal to prejudice based on race, creed, national origin, religion, gender, physical disability, or sexual orientation.
4. 1 shall not, without just cause, attack or question my opponents patriotism.
S. 1 shall not publish, dispiay, or circulate any anonymous campaip, literature or poNizical advertiserierit.
0
1 shall not toleraTe my supporters Engaging in these activities thm 1 condemn, nor shall 1 auept their wrNsrfued SUPDOrt 51,_0
M. 'n8y 011gage 11
such activities. 1 will Plot permit any member or my campaign organization to Engage in these activities and will immediately and publicly
repudiate the support of any other individual or group that resorts to the methods and tactics 1 condemn.
7. 1 shall run a positive campaign emphasizing my qualifications for office and 'positions on issues of public concern,
8. 1 will limit my attack., or, an opponent to legitimate challenges to that fierson's record, qualifications, and nOSitions.
9. 1 will neither use nor permit the use of malidous untruths or innuendoes aboui ar. opporient's person.al fate, nor 1 roal kie or condone
unfounded accusations discrediting that Person's credjbillt,'.
10, 1 will take Personal reSpwnswil:ty for approvin', or disavowing the substance of attacks on any opponent that may come from third parties
supporting my candidacy.
!L il will not use or permit the use of campaign material that falsifies, distorts, or misrepresents facts.
BY S!Gllq-tT 14 G THIS DEC-LARATION AND FIRST AMENDMENTWAII�ER,I AGREE 11)
17
ABIDE BY THE VOLUN TAR STATEMENT OF FAIR CAMPAIGN PRAC-710ES,
SUBMIT TO THE CONrPULSORY JURISDICTION OF THE ETHICS COMMISSION,AND
WAIVE MY FIRST AMENDMENT RIGHTS.
tlsa� 1,
a candidate for the office of
please print your Parne
C yk�AAJ ft k�VQ
county,m-tannpahi,_or oche;,w,ca,Ooil
agree to abide by the voluntary Statement of Fair Campaign Practices as provided in Section 2-11.1.1(D)(1)of
the Code of Mi ami-Dade County,Florida, and to recolanize as compulsory the Jurisdiction of the Ethics
Commission. I further agree that the Ethics Cor-runission ,vill have ithe authority to decide whether I have
violated the voluntary Statement of Fair C_qmpa4Ln Practicts and, it v..olag lon is i,ou-nd, the E01ics
Com-mission has Lhe authloriiv to,impose the allp-prcIprilate-p--naloy, an', whir"'I n-, iii CJL� _�- "i, a'sily
ia R ii o
public reprimand. I recoginisle th.at it have the ri,ght,before signing this DEC AIIFZ.ATION AND FiRST
AMENDMENT WA17VER to consult my own legal counsel and to request and receive from the Ethics
Commission an advisory opinion as to wbIet her my planned campaign activities are likely to violate the
voluntary Statement of Fair Came-paign Practices.I al so recognize Idiat after signing this aureen-1-int,I will
continue to havethe fight to request and receive froan the Ethics Corranission an advis(li_y opinion regarding
any future campaign acolvities that_1 may be considering. 1 hercby PFOCJ�11'
i -,1 �7 't-P,�,i [Mil it aizi-cei-rienI to a`&, by
h Statement,.0f Fa-r Cat npal,,,ri Pracn*ces is volemleu:)%111nowirl ly, LrId ill 01 fizg1-ill, (2 th-]-., 1 h, <�'e not b en
i_
forced,pressured,or otherwise coerced into making this agreement. 'and'k'3)that 11 am aware of the volunitaty
nature of this ai -here is no penalty for refusing to agree to abide by the voluntary
I �reernent. 1 recognize that t
Statement of Fair Campaign Practices. I also reco,cmize that in si-n-In-this agreement. 1 will be forfeiting
ri-hts to which T would otherwise be entitled under the First Amendment to the LJ.S. Constituilon and Article
Section-,`, of the Constitution cifthe State of Florida.Once the DECLARAT10N AND FIRST
AMENDMENT WA IVER is sil-ned. it deerned,ii-r1�voc-aNe for'he duinado-n olf'the cou-npaiAla.
2-
Signa dre Date
COE,revised 5/20 1,0
RECEIVED
3 Form 6 - Fall and Public Disclosure of Financial Interests OFFICEF THE CITY
i
AUG1 4 2 24
Name: Dr Michael Isaac Jacobs CITY OF AVENTURA
Address: 20875 NE 31ST PL,AVENTURA, FL 33180
County: Miami-Dade
rgrtrztr ! uborgr�tattcrn Tl
N/A
CANDIDATE FOR
City,Town or Village(Commission or City of Aventura Commissioner Seat:
Council},Governing Board
My Net Worth as of December 31,2023vas 3 1}0 000.�00.
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Printed from the Florida EFDMS System Page 1 of 7
2023 Foy - Full and Publicl Financial Interests
Household goods and personal effects may be reported in a lump sum if their aggregate value exceeds$1,000.This category
includes any of the following,if not held for investment purposes:jewelry;collections of stamps,guns,and numismatic items;art
objects; household equipment and furnishings;clothing;other household items;and vehicles for personal use,whether owned
orleased.
The aggregate value of my household goods and personal effect is$200,000.00.
ASSETS INDIVIDUALLY VALUED AT OVER$1,000:
Investment Home $507,100.00
Investment Home $556,000.00
Home Residence $ 1,380,300 00
77
Stocks and Bonds $96,586 t"
Bank Accounts $5551 .66`
Car Ownership
Car Ownership 46 17i 0
Florida Pre aid Tuition Plan
p $2T,776.57
Florida Prepaid Tuition Plan `
p � � £ $12,782.79
North Miami Dental Group LLB $9 {l 00k0w
Hallandale Beach Gepp LLC $ QO}f3t101t ,,
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Printed from the Florida EFDMS System Page 2 of 7
2023 For - Full and Publicis s r Financial Interests
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.,ems,S✓ zo�.."�`�',,.,, �,a,,.-/� �,,,.2,:,,„ , ,. .,, ,�,h; ,.,, '
LIABILITIES IN EXCESS OF$1,000:
LOW MOM
SPS,Inc P.O. Box 65250 Salt Lake City, UT 84165-0250 $317,504.33
SPS, Inc P.O. Box 65250 Salt Lake City, UT 84165-0250 $342,555.59
SPS, Inc P.O. Box 65250 Salt Lake City, UT 84165-0250 $809,298,77
Wells Fargo Dental Practice
Loan 420 Montgomery Street San Francisco, CA 94104 $392,210; 8
TD Bank Dental Practice
Loan 1006 Astoria Blvd Cherry Hill, NJ 08003 $ 03r4 9 ,
Wells Fargo Credit Card 420 Montgomery Street San Francisco,CA 94104 $3868 95
TD Bank Credit Card 1006 Astoria Blvd Cherry Hill, NJ 08003 '$1,800.Q0
Henry Schein Credit Card 1620 Dodge Street,Omaha, NE 68197 = $36,9714
Wells Fargo Auto Loan 420 Montgomery Street San Francisco,GA 9 �04' $8,26 ,79
Bank of America Car Loan .0. Box 942019 Simi Valley,Cl 9 t94 2 4 79 3 �9
Chase Ink for Business Credit P.O. Box 6294 Ca rgi Stre ILhE017.6294 $41,050.92
Card
JOINT AND SEVERAL LIABILITl 9 NOT REP ,RT1� AWVE:
61
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s
N/A
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Printed from the Florida EFDMS System Page 3 of 7
2023 Foy - Full and Public Disclosure of Financial Interests
/
/
�,', v,"�,�.-�� �N<�,.,.,,��ss., ✓. as�.,� T,.� ,p_:. _ mac,.,.,? `` fir/ �
Identify each separate source and amount of income which exceeded$1,000 during the year,including secondary sources of
income. Or attach a complete copy of your 2022 federal income tax return, including all W2s,schedules,and attachments.
Please redact any social security or account numbers before attaching your returns,as the law requires these documents be
posted to the Commission's website.
® I elect to file a copy of my 2023 federal income tax return and all W2s,schedules,and attachments.
PRIMARY SOURCES OF INCOME:
too
Hallandale Beach Dental Group LLC 2100 E Hallandale Beach Blvd,Suite 305,Hallandale
p 58;18� 68
Beach, FL 33009
North Miami Dental Group LLC 15400 Biscayne Blvd Suite 116, North Miam, L 3310 6 92
�,.,,
Sabina Lynn LLC 20875 NE 31st Place,Aventu ,FL 3318Ct $1R,600.98
f
SECONDARY SOURCES OF INCOME(Major customers,clients etc,of b �nesss,owra" d by reporting pers4
� essofSre
970
Candidate did not complete
section.
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Name of Business IEEtty [t[orth Miami 1r ntaI Group LLC
Address of Busirssitity ° �35400 Biscayne Blvd,Suite 116, North Miami, FL 33160
C1
111
Principal Business Activity 15400 Biscayne Blvd,Suite 116, North Miami, FL 33160
Postion Held with Entity President
I
Printed from the Florida EFDMS System Page 4 of 7
2023 Foy - Full and Public Disclosure of Financial Interests
I own more than a 5%
Interest in the Business Yes
Nature of my Ownership 100%Owner of Dental Office
Interest
!TiMupityBeach Dental Group LLCntitylandale Beach Blvd,Suite 305, Hallandale Beach,FL 33009
Principal Business Activity 2100 E Hallandale Beach Blvd,Suite 305, Hallandale Beach, FL 33009
Postion Held with Entity President
1 own more than a 5%
Interest in the Business Yes
Nature of my Ownership 100%Owner of Dental Office
Interest
Name of Business Entity Sa>ttraa Lynn
Address of Business Entil., 2087gVMt Place,Aventur
Prinap usme Activs 20875 NE 31st PlaCe"WAveC Zara, lw 180
h
Postion[d id with Entity VP
I own more than a 5%
Interest in the k1s#net& s
r 1.
Nature of my OvuYtsship 50%Owner
Interest
Name of Business Entity Benas Ventures LLC
Printed from the Florida EFDMS System Page S of 7
2023 Foy - Full and Public Disclosure of Financial Interests
Address of Business Entity 20875 NE 31st Place,Aventura, FL 33180
Principal Business Activity 20875 NE 31st Place,Aventura, FL 33180
Postion Held with Entity VP
I own more than a 5%
Interest in the Business Yes
Nature of my Ownership 50%Owner
Interest
Name of Business Entity Puppa Caller Pittars Films LLC
Address of Business Entity 20875 NE 31st Place,Aventura FL 9
Principal Business Activity 20875 NE 31st Place,Aventura FL 318Q ,
Postion Held with Entity President 1�
a
I own more than a 5% .
k E
Interest in the Business Yet °
:
Nature of my Ownership t 50%Cher`"'
Interest
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Name ofl0t�s9ness Entity Softball 2 Cur
r
Address of Busines�Entit / �' 087 NE 31st lace,Aventura, FL 33180
Principal Busi ity W a 20875 NE 31st Place,Aventura, FL 33180
Postion Held with Entity President
I own more than a 5%
Interest in the Business Yes
Printed from the Florida EFDMS System Page 6 of 7
2023 For - Full and Public Disclosure of Financial r
Nature of my Ownership 50%Owner
Interest
JJf 3f .0 .� Y' 3Y✓:6 �
WIN
Name of Business Entity Michael Isaac Jacobs DMD PA LLC
Address of Business Entity 20875 NE 31st Place,Aventura, FL 33180
Principal Business Activity 20875 NE 31st Place,Aventura, FL 33180
Postion Held with Entity President
I own more than a 5%
Interest in the Bu0ness Yes
Nature of my Ownership 100%Owner
Interest
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Under the penaities of perjury teclahat! ie read the foregoing Form6 and that the facts stated in it are true.
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icha /aa�I c® s
Digitally signed:01/12/2024
Printed from the Florida FFDMS System Page 7 of 7