Corey Lafferty/Ocean-Fairwind LLC?~ MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center drive, Miami Beach, FL 33139
LOBBYIST REGIS'I'RAfiIQN FORM
Lobbyist means aN persons employed or retained, whether paid or not, by a prindpat who seeks to encourage the passage, defeat
or modification of any ordinance, resolutmn, action ar decesion of any commissioner; any action, derision, recommendation of the
City Manager or any aty`board or committee; ~ any action, dec~ion or recommendation of any city personnel during the time
period of the entire demon-making process on such action, dec3sbn or recantrr~endatbn that toreseeabiy wiN be heard or reviewed
by the dty oxnmission, or a city board or eomcnittee. The term specifkaNy includes the prinapai as well as any emP~ ~+9a9~
in lobbying activities. Tfte t:et't11 "LObbytats" I~as specific exciusions. Piease refer to Ordinance 24104-3435.
of LOBBYIST: (Last) t~~) i D a NE. 3~T'7t si
Aus~Al T• cSftk.~ NA3-iy R Q ~.#f'1 T`~c.#T, P. •~t M ~ An?r , F' ~. 3 3 ~ 3 7
BUSINESS NAME AND ADDRESS (Number and Street) (CRy) (State) (Zip Code)
3~~~ '7~ •009 "3d5' ~~~.. O! "y ?~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LQBBYISfRETAINED BY:
NAME OF PRINCIPAL/CLEENT:
4 os L.rnJco c..N R~ ~'3.~ri M //3~n'1 / l3 fi9~~F ~~. .~ 3 / 3 9
BUSINESS NAME AND ADDRESS (Number andStreet) (City) (State) (~P ~)
~ ~' ?77 -- 73 7 3 ~~QS" - 777 -- 73&'fi
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
FII out this section if principal is a Corporation, Partnership or Trust [Sectlon 2-482 (cp
NAME OF Ci1IEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 596 OR MORE OWNER5HIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP flR TRUST:
II. SPECIFIC LOBBY ISStfE:
FA ~ Q.w i ~ z> rta T.~ _ F moo r., p c.~Ny ~t ~1 N ~ b im f?,~.rr S bA-~i?J9
Issue to be lobbsed (Describe in detail}: ~»I--'~ ~,,~ d~ ~~.{~
III. CITY AGENCIES/INDMDUAIS TO BE IaBBIED:
A) Full Name of Individual/Tide B) Arep Finandal, Famiiiai or Professional Relationship
Cyr ~ ~. pay r N f ~3-l'`F o
c~ A'TI~~N S• Pf= /
M~ off'. t ELt~ ~ i?"~.M t 5 S t O
7-'~ ?tip.. g x_T'~,~rT" f''riQ,.H. t ~St~3'
IV. bISCL03URE ~ 7EttM5 AND AMOlA1'T5 OF L098riST COMPENSATION (DLSCtASE YYNETHER HOURLY,
~T:~~~~~ alQned ern to Cof Jia~ T Sl~u.l~.a.~
q L.088YIST oiscrpsuai=: c~u~ea)
e) PRINCI-AL'S O35t~.OStIRE (OF L.086YiST COMPENSATION): (inEpuirad). J
The foilowinp iAtornrallon nwct be ar~rerod: ~~~
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i) Pursuant to Miami Beach City Code Seebon 2-488 Entitled °Profiibited Campaign Contributions By Lobbyists
On Procurement Issues":
3) .~~~ Pursuant to Miami Beach City Code 2.484 (h):Any Person (except those exempt fmm the defirritlon of
` "lobbyist" as set forth in SeWor- 2.48i abore,} who orgy appears as a represer>tative of a not-for-Profit
corporation or er~tily witltout special oa~er~sation or rei~t for tfie appearance, whether direct, or
~redy tD express support of or to ar>!r item, shall. register with the deck as required by this
section but, shat not be wed to AsY any regTstratlon fees:.
V. 5I6NATURE ilNDER OATH:
ON OCTOBER 1~ OF EACH YEARf. EACH lABBYi53' SHALL vim. 9MIT TO THE CITY CLERK A SIGNED
STATEMENT UNQER OATH, Li~3NG E>~END~tlRES, AS 1diELL ODMPENSATION
RECEIVED, IN TliE CITY OF #lIAMKI FOR THE PRECE~U`LG GAL N A STATEMENT
SEfAI.L BE FILED- EVEN IF THERE HAVE BIB! NO E~ENDI OR TION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoting~facts are true and correct and that I have read or am
famHiar with the provisions contain ini~~/l~C 2-482-of the Miami Beach City Code and ail reporting
reQuirements.
Signature of Lobbyist:
Signature of PrincJpal/Client:
VI. L088YIST IDENiTFICATiON:
Produced ID
Form ~ Identification.
Personally krrorvn (Lobiryist)
VIL SIGNATURE AND STAMP OF NOTARY:
State of Fkxida, County of Miami-Dade
Sworn tiD a subsc~ me /~
is 2QSL~
Signature Notary - State ~ Fk>rida
N. aF Lobbxict's dgnatiun
i, Produced ID
IOENTIFiGT20N:
Form of Identlficaaon
i(sPer~rraNy known (Prirxipai)
~ of Fbrida, Courrty of Miami-Dade
Sworn and su before me
This U ~ daYbof ~k.L.c,~ . 2tl~
Sigrwture of Pubik Notary -State of Fkxida ~-
Notarizatlon w PrhrdpaMs signature
Y
Mnual Reglslrationa: [ Yes [ J Ho Pa' MCR * Zq (?3~1 Date void / ~- ~?
lobbyist Reyislraliiin-Form reocived and verified bY:
f:~ClER1i1W.~FiARIA-MiLobbyist~LOBBYL41"toRM ~ Revised 12/08/04
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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.
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
8%
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
Casper R. Callen Trust
618 East Broughton
Savannah, GA 31401
Beneficiaries:
Robin Callen
1507 West River Lane
Tampa, FL 33603
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 0
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%
P O Box 7142
Winter Haven, FL 33883