Claire A. Callen/Ocean-Fairwind LLCa~ ,M,,gMIBEACH
City of Miami Beach Office of the City Clerl<
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 refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
c3oS-~~'7-373 ~oS--7~7-7359
TELEPHONE NUMBER. FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT: '
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
,~ US - 77-1 -
TELEPHONE NUMBER:
out this section if
4S- 7`17-
FAX NUMBER: (Op
is a Corporation, Partnership or Trust [Section 2-482 (c)
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: (,' LA c2 ~ C~,~4L-(.-¢,N r ~'Ll4~Ni~}Cr~U~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: t7 C4A-n15cDT= IQ rcSO~-~[ /(l.l C
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Descnbe in detail); ~ J[ ~'tNS / 0 /J
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
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B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERj.
A) LOBBYIST DISCLOSURE: (Required) N o /U ~ OT7'f'4~° 715~-f3N /1/D~~IgL- __~ HPf~/S R-T701J
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):(Required). ~~N~ DTJ7"G~' Jz-~}!ll/t~0'pM~4L- CD/~~/U~7a'
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O~n Procurement Issues":
^ Yes t~No: Are you lobbving on a present or pending bid for goods equipment or services or on a
present or pendina award for aoods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
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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 anot-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 [9'No: Are you representing snot-for-profit corporation or en1i~ without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURE,~S, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING: CALENDAR. a'EAR. -A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION ~ DURING THE
REPORTING PERIOD. /
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Signature of Lobbyist
I do solemnly swear that all of
familiar with the provisions conf
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: p~ ~
J cp N
i i Produced ID ~ ~ N z
Form of Identificati~tz .~
w ° o
i , Personally known (Lobbyist) w ~ ~; e
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VII. SIGNATURE AND STAMP OF NOT~t~'.a~<.
~ue and correct and that I have read or am
the Miami Beach City Code and all reporting
IDENTIFICATION:
i1 Produced ID
Form of Identification
u~ersonally known (Principal)
State of Florida, County of Miami-Dade JOG. 6~'do
Sworn to and subscribed before me ° ~~ LL
This i_~i~_day of ~.l L~r~%sc. , 20 C~~ 7 ~o~' ~°
Signature of Public Notary - ?
Notarization of Lobbyist's
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State of Florida, County of Miami-Dade
Sworn and subscribed before me
This IS'i~day of ~ t, N 20~~`
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLE S ONLY /
Annual Registration fee: ]Yes [ ] No Amount Paid MCR ~~ Date Paid
Lobbyist Registration Form received and verified by:
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OCEAN-FAIRWIND LLC
DISCLOSURE OF INTEREST
Member Name, Address & Office % of Ownership
Oceanside Resorts, Inc. 100%
605 Lincoln Road, #320
Miami Beach, FL 33139
Disclosure of Interest for Oceanside Resorts, Inc.
(dome, Address & Office % of Ownership
David Callen 8%
8870 North Himes Avenue, #242
Tampa, Florida 33614
Robinson Callen Trust A
PO Box 403367
Miami Beach, Florida 33140
Beneficiaries: Claire Callen
c/o Oceanside Resorts Inc.
605 Lincoln Rd, #320
Miami Beach, FL 33139
Lana Callen
865 North Shore Drive
Miami Beach, FL 33141
Robin Callen
1507 West River Lane
Tampa, FL 33603
Gasper R. Callen Trust
618 East Broughton
Savannah, GA 31401
Beneficiaries:
Andre Callen
c/o HI Development Corp.
1 1 1 West Fortune Street
Tampa, FL 33602
Sean Callen
c/o HI Development PR
1004 RH Todd Avenue, 3~d FL
San Juan, PR 00907
Ian Callen
c/o HI Development Corp.
1004 RH Todd Avenue,
San Juan, PR 00907
Dorian Callen
PO Box 2669
Winter Haven, FL 33880
Desiree Callen O'Neill
425 Lake Ned Road
Winter Haven, FL 33884
Tarquin Callen
46~
33.3%
33.3%
33.3%
46%
14.29%
14.29%
14.29%
14.29%
14.29%
14.29%
c/o Callen Trust
PO Box 8747
Savannah, GA 31412
Justine Callen Bohannon 14.29%
POBox7142
Winter Haven, FL 33883