Michelle Kohler/Ocean-Fairwind LLCm M',AMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST I2EGISTRA'TION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modifcation 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.
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NAME OF LOBBYIST: (Last) (First) (M.I)
Oc4~n)s +asr ~'~s~ ers /Nc. C,os Linlco uu ~ ~ ~aQ M,y-M~ ~~+~ F~ ~3 ~3 9
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Z.ip Code)
has - 777 - `13~~
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
FAX
~'p ,STS • N c~T
Q C4.~ - Icft/~wla1 D LLL'.
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
3a~~-77Z- 7373 ~o~-7y7-73bq
TELEPHONE NUMBER: FAX NIrMBER: (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: C L ~~Q ~ e~'L'«N I ~"~PrN~~
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECl'LY, A S% ORnMORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: b(~-NS ~.D SL /art SO ~-7-5~ /~ ~'--
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail): ~~CT~G.JV S /~ 1"'
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
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- ~ ,,-y ,~o M,~,s - noti -
C ~-r-y s A-rr~~2~vQ-c,(S a F~-~ e4 N ON ~.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr
- d Na n< f. a 79~H9-~ A/0 ,erv~~t_ Crj~frenl S ~47't o a)
A) LOBBYIST DISCLOSURE. (Require) -
NO N E 67'tf~c-t° 7~N N~'eN~~l-L Cb/~B~ sA~i~
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":
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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..
q Yes f~TVo Are you representing a not for Drofit corporation or entity 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 EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. 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 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 Miami Beach City Code and all reporting
requirements. r .~~~
Signature of Lobbyist:
,~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: RINCIPAL IDENTIFICATION:
n Produced ID _ ; i Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) i I Personally known (Principal) ~~~~'~""'~"
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VII. SIGNATURE AND STAMP OF NOTARY: ~ ~
~ ~> i tate of Florida, County of Miami-Dade State of Florida, County of Miami-Dade ~ °
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'~ '~ I worn to and subscribed befo e me Sworn and subscribed before me nW. ~ ~aa
o ~, z ,This 1 S day of , 20~ 7 This 15 day of , ZOO ~ ~ ~ ~
U W
S v3 iii ~ Signature of Public Notary -State of Florida Signature of Public otary -State of Florida ~
`+' ~ x ~ Notarization of Lobbyist's sig ure ization of Principal's signature ~„~o
w FOR C ONLY ! •~, '~.'~o
„~ Annual Registration fee: )Yes [ ] No Amount _ I MCR Date Paid ~ .~ i L~ s~~f,)it1i;PM
,i ~ Lobbyist Registration Form received and verified by:
~ ~~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
OCEAN-FAIRWIND LLC
DISCLOSURE OF INTEREST
Member Name, Address & Office
Oceanside Resorts, Inc.
605 Lincoln Road, #320
Miami Beach, FL 33139
Disclosure of Interest for Oceanside Resorts, Inc.
Name, Address & Office
David Callen
8870 North Himes Avenue, #242
Tampa, Florida 33614
Robinson Callen Trust A
PO Box 403367
Miami Beach, Florida 33140
of Ownership
100%
of Ownership
8%
46%
Beneficiaries: Claire Callen 33.3%
c/o Oceanside Resorts Inc.
605 Lincoln Rd, #320
Miami Beach, FL 33139
Lana Callen 33.3%
865 North Shore Drive
Miami Beach, FL 33141
Robin Callen 33.3%
1507 West River Lane
Tampa, FL 33603
Casper R. Callen Trust 46%
618 East Broughton
Savannah, GA 31401
Beneficiaries: Andre Callen 14.29%
c/o HI Development Corp.
1 1 1 West Fortune Street
Tampa, FL 33602
Sean Callen 14.29%
c/o HI Development PR
1004 RH Todd Avenue, 3~d FL
San Juan, PR 00907
Ian Callen 14.29%
c/o HI Development Corp.
1004 RH Todd Avenue,
San Juan, PR 00907
Dorian Callen 14.29%
PO Box 2669
Winter Haven, FL 33880
Desiree Callen O'Neill 14.29%
425 Lake Ned Road
Winter Haven, FL 33884
Tarquin Callen 14.29%
c/o Callen Trust
PO Box 8747
Savannah, GA 31412
Justine Callen Bohannon 14.29%
P O Box 7142
Winter Haven, FL 33883