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Allan Shulman/Ocean-Fairwind LLCfhl , by ~;e, ti':"i c=.~mrsz:s~:~ ~~ A~X TI. SPkCI~"IC Lt3f3i~Y ZS4L8'r: iT'~. t` rte'' ~ ka"s r~~ art;z€ Cc.c:s~,;~ 2 ~i82 {e)1, *1. + I Fu, axsc~.r,~su~E c~>: ~ ~~zr~ss ~~~ ~r~o~ra7s ai= Losavxs~r corz~Ervs;aTZ~ra {o~sc~.~s~ cnr:-`~r=~ t;~durxcr, "1 Yes o Are.._3abb €n an ~ presant~ as 0r.ciin ;_.. tie as s e €a _ . ~,.. r ~re~ent or ~Pncfina sward for gads eastnsnent.ar s~ruire? 2, €=llrSUs.n~ to ^~`,>,~,; Eearh City Code. ~-ag~ cnti(°d "~rc~hio';~t! Carr.naiGn Contributitns ?? L~.~bylst; ~,: f;eui L,.yle ~c;veES}pn~ent Iss°aes": .Yi c~ aend'ana 3I2.~31t~."itiaR far 3 G},C~'_V@iOj,7'Ci1~rSt .~SC3r£'4"..22:P's~ t^JIY~S ti_____G' ~4t~{)r "`1YCS C A ~C4 dabE3 ii ` -~ . _. 5 ,?~~u,re_La~~d [15e ^_ ~piicat"snr. for change of z~7nirrc~ ma cfe, l s~~t€cst~ ar chang~ to fhe, uit}r ~S~nn? 't wrsuant €'G ~'sar=ti Q°aCh City God2 ~-~~4 ("7 r n~+ p~ sin ~ex~et~t tl1'~~u 3 xer ~ t fr , ~ ~e u~ +,u;~t of „I~±~b;°i5i' as set f,~rth i:r~ Sccti~,n 2_?fit ~~c~4e; .~'.~. ort,j at~pears a5 a re>rF~ i~ti ~ of .~ ro r ,~roit ,. r r rei-t a -~ a Its` . . . „~~rpG•rati>:rl ear en~,t1° ~~€tho +t SUectdl ~On-rpara~~i„ri Syr , ~°rbur,,~rnent far e apr4 ..~~ ~ . ;ndir+act, to express sii~p~r-i cf ar c,p~asti~r ~+, a^y t,cr:~, s,,..fi ~esi:5.er .,+th the c:e.r.. a.. ~rlu,rca by s, ,:a ~"tian taut, sit<~: nUt be re~uircc to p+iiy a;~y regislratan fees.. se / Yes ?~'T,tor Are Yo~€ ret~resent'snc~a no -far- rofiti cgr~_ ion, or~ -~ntaty withorsfi ;r~~c~.'z ..~~y~?~S car,reinab~sssement-; . V. S3t~~3I~7UitE Ut~EDESt {)A't'ht: C7i~i OCTGBER 15' 4F ~A:.~€ YEAF2, EAGfi LO~SYIST SHALL St;~t~FTT ~t7 THE f ~''"f : `'"itK r~ SIGttiEt3 srA~~rw~ET`a~ ur~cs~~t c~A~H, LiS°~~+~ LQ35YING ~x~era~~,uiz~s, As w~LL As ~,;i7ME~Et~aSATiO?~8 ' 3 RECE?VEU, IFit °sHE Ca-`}' OF r~ZAI SEACH FOR 'I.3-lE FRECEi/~€~1G CALEt~lCkAk YEAi2. A SaraT:'M1EN L BE ~ILEIa EVE~d Z' TNE€YE HAVE 6EEI4 6YtO ExAEPaG~Ti.3r2ES OR C~h1F~t~ISA~'ar,`~' C3E:'2I'+dG THE 53iA£ , 6ZEFC~(~°~TblG PERIC7D. / ~ j ~vlU( ____ ~~ _ 5~.3~atu ~ ~~` lcu:ayist I sio solcmr7fy Gwear that a(i of `I^e fGrecj`~in~ facts are true ar€d ~:crr;tt and +~at I "'~ ti~~ °cad cr am ~ar:-Effar vrth the pr~~,fsions c©r~tainecl in 5~ctUr ?-~~32 cf re ~tiar;r each C;~,, cerje a,-;rj mil r.>~~rC;r; rer~u;rer<,entM, / ~~ ~ ~~" ~',, ~r~r~ature of Lobbyist: ~~~i ----~ ~-~---~ .--=-.~~. __._.__.e._..~_~...~~__ ~ , ~ Sir~nature of ~rincl~al/~€iert: ' ~_ ~`~ ~ ° ~~ vT. ~.+a~~a~rsr>a~~s-rtcar~o~v: ~R~rac~~A~.r~~r+~xl~c~r~~r~: ooh ~~ ..;Z 1 Produced ~~ ; >'rac~.rce~ ?~ _.___ _ _-•- d =:" d ~ o ~ c~: 1.~~,cr± „ -~ ~L ~ Fcrrn of Identifcalian Form o` s `` ca ~ o S o p M cV / R ~ known {Print"spas} ~ er~sonafl i ~ ii Lobb t k ~ ~ ~ y } ncw n ( y s y } erscana E~ V "~ c~ b: wO ~-+ Q N c ~~'''-'~~ ~ VIi. 5TGNA7l1RE ANU STAr~9P OF h'st3TARY: ',*~4r~`~o ~ ''~ LL 'E¢~.~ ~ ~ ~ ~ State of i-I;~n-~a, Counl of r':l~€r€-Cede scale of Flrridr, C:;unty or J~ at7 i Gaya ~ N ~ . V ~ a , : •-" s~w~crn tc any subscribe be`a~e e *+n~arn --{[ d subs~,rbei be o e rz:e t h(S _d~y Of~ ~~~ ThIS 1 ~Iy as ~ l,~ /~/ 4. ~ z~ l'~ ~7~~ ~~ ~ W ~ .-7 . r. O f Il ' L.-~-"' ~r ~~>1~ ~ ~~' ~ Ga. V W ~ ~ . _ _ .~,. . W. e . _ _ _. ~ ~ ~~ _. __ Signature rf Public Ncca gate of ~larida , -_ S.~nature of P+„bl~c. I~~atary ~tatc T riorlcia ~ arrzatir~n of Principal`s signa~aare tVat~rizatian ate Lablx sst's ssgnat~re ----- ,~ FL? R ~GL Y ~''/ fi~ ~ ~ ~ `~ ~'~ _....~.~/ . ~ FigllEid{ Re~iStra[ir~n fop: ~~^. Yea i );rva mGJ~` r~ ~v ~~Iw~ v~~~st ken ~craiior Fr^rrn reesi~~;; an verift~ ~ ~ _ T"" r ~ LFk1;Sr ~.~. ; ^ R:A .~1L~ ;Cys~`,~C~?~ :S a' ` 1 c c,r. ~:evfs~~ -~, ;~;; ~„ 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 % of Ownership David Callen 8% 8870 North Himes Avenue, #242 Tampa, Florida 33614 Robinson Callen Trust A 46% PO Box 403367 Miami Beach, Florida 33 140 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