Okaloosa County BOCC — June 17, 2014 — Gen Info,Wet Slip, Gross Income Reporting & Cert Forms June 2014 — reading text

2013/2014 Wetslip Information Form Lessee: OKALoosn Coury Instrument No: 4600] 768! I. INFORMATION ON WETSLIPS LOCATED ON STATE-OWNED LANDS 1. Number of Temporary Slips - Slips that are not rented and are used as fuei docking, launching or removing boats, restaurants, or store purchases. O These slips should be Non revenue generating slips. 2. Number of Transient Slips- Slips that are rented on a short term basis. 0 3. Number of Public Slips - open to the public on a "first come, first served" basis. - Rental term shall be no longer than one year and with no automatic renewal rights or conditions. 6 (0 4, Number of Slips Not Usable - Slips that are silted in or are in low water. 5. Number of Slips Sold, Subleased, Licensed, Assigned, etc. - Aifach a copy of the document which represents the sale, sublease, license or assignment. The document should include the sublessee's name, unit number, the slip number, and the amount of the transaction. 9 6. Number of Private Slips, not rented to the public - Slips used for personal mooring, Association common area, etc. Is your facility a Pier with Admission Fees? yes) NO “Circle One Boating has a tremendous economic impact on the State of Florida each year. In an effort to learn if boaters have an adequate number of slips around the state, we are requesting information on wetslips that are not within a state-owned submerged land lease. No income generated from these slips is to be reported. ll. INFORMATION ON WETSLIPS LOCATED ON PRIVATELY-OWNED LAND 4. Number of Slips Sold, Subleased, Licensed, Assigned, etc: 2. Number of Public Slips - open to the public on a "first come, first served" basis. 3. Number of Private Slips, not rented to the public - Slips used for ing, Associatio etc, 2013/2014 GROSS INCOME REPORTING FORM Lessee: OKALOOSA Covury BCC Instrument #: 46001768] Direct Income Indirect Income All income received directly by Lessee from _|All income received by someone transactions within the lease boundary. * other than the Lessee for transactions involving the use of state-owned submerged land g 3 - , May 2013 [si 318* 5 38047” June 2013s $__ 85,904-47 July 2013 Js $ €0,963”? August 2013 $ " $ 32747! September 2013 —|s_— $2325, October 2013S Is" $ 20,343° November 2013, fs $s 10,252% December 2013 $ " $ 5, fo1™ January 2014 $ ‘ $ 2,645 8 February 2014s $ 456875 March 2014 [ss 31839 $16,345 April 2014 $ {3,582 g _27760° TOTALS $ 138, 083% $ 303240°% Enter Zero | if slips are non-revenue generating or generated $0.00" * Income is defined in chapter 18-21.003, Florida Administrative Code, as the gross revenue derived directly or indirectly from the use of state-owned submerged lands such as slip rental, lease or sublease fees, dock or pier admission fees, club membership, stock ownership or equity interest in activities where increased revenue is attributable to the use of the submerged land. However, gross revenue shall not include pass-through fees such as fees for utility services, sale of the facility or sales of products not occurring on sovereignty submerged lands, Gross revenue shall Include all future payments made for the transfer of the interest in a slip originally obtained from the Board’s lessee, including transfer of slip rights by slip sublessee's, slip “sellers”, slip interest transfers, new club PLEASE ATTACH A LIST OF ANY SLIP TRANSFERS AS DEFINED ABOVE INCLUDING THE SLIP NUMBER, AMOUNT OF INCOME RECEIVED, SUBLESSEE'S NAME AND UNIT NUMBER, IF APPLICABLE. FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF STATE LANDS 3900 COMMONWEALTH BOULEVARD, MS #100 TALLAHASSEE, FLORIDA 32399-3000 (850) 245-2555 CERTIFICATION Instrument No. 46Q\768 I Lessee Name: OALoosA Country BCC Billing Address Boz NAN. Wyse) ST Sure Boe City/State/Zip CRestview, Fl Telephone: (850) 689-5770 (Please provide area code) Facility Address: 300 Pier Roan City/CountyZip: ET Wats pred | okmocea /32548 |, being first duly sworn, hereby certify under penalty of perjury that the following statements are true: (1) To the best of my knowledge and belief, the information contained on the Wetslip Information Form and the Gross Income Reporting Form is true and correct; (2) | have read and understand the terms and conditions of the sovereignty submerged lands lease, and the facility is in full compliance with all the terms and conditions of the sovereignty submerged lands lease; (3) 1 am authorized to execute this certification on behalf of the lessee; and (4) ! am aware that any intentional false statement herein will be grounds for cancellation of the sovereignty submerged lands lease. Signature of Lessee Printed Name of Signature Title Date STATE OF COUNTY OF Sworn to or affirmed and subscribed before me the day of ,20 , by Personally Known (SEAL) UK Froauced idenurtication Type of identificaiton produced Notary Signature Commission Expires fish senior child pass watch May 2013 32798.67 1722.53 1865.43 1661.26 23989 38047.89 June 2013 45933.02 1967.73 §757.03 2246.55 41993.08 55904.33 duly 2013 50069.74 1624.45 7250.22 2018.82 45551.27 60963.23 Aug 2013 32260.41 919.5 4193.36 901.64 28774.94 38274.91 Sept 2013 19421.29 1520.24 1437.36 872.28 17403.46 23251.17 Oct 2013 15828.77 1667.36 1984.32 863.17 15791.55 20343.62 Nov 2013 7989.1 680.43 771.68 811.46 5643.94 10252.67 Dec 2013 3888.5 343,28 428.24 1207.52 3424.14 5867.54 Jan 2014 2164.82 212.66 216.24 47.16 2627.16 2640.88 Feb 2014 2833.64 506.9 214.35 1013.86 4765.8 4668.75 Mar 2014 10843.67 901.11 1633.32 1966.93 13832.73 15345.03 Apr 2014 22639.63 1396.21 2460.58 1283.62 16877.25 27780.04 246671.26 13462.4 28212.13 14894.27 220684.32 303240.06 onsen By Pee Agsocimaes e[afi4