Okaloosa County BOCC — June 16, 2015 — Gen Info, Wet Slip, Gross Income Rptng & Cert Forms June 2015 — reading text

2014/2015 Wet Slip lnformatieh Form Lessee: Instrument No: 1. INFORMATION ON WET SLIPS LOCATED ON STATE-OWNED LANDS 1. Number of Temporary Slips - Slips that are not rented and are used as fuel docking, launching or removing boats, restaurants, or store purchases. These slips should be Non revenue generating slips. ("} 2. Number of Transient Slips- Slips that are rented on a short term basis. & 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. C) 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. - Attach 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. @ 6. Number of Private Slips, not rented to the public - Slips used for . personal mooring, Association common area, etc. 0 Total Number of Slips on State-Owned Lands, Add lines 1 through 6 O - Is your facility a Pier with Admission Fees? (’%E/S 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 wet slips that are not within a state-owned submerged land lease. No income generated from these slips is to be reported. Il. INFORMATION ON WET SLIPS LOCATED ON PRIVATELY-OWNED LAND 1. 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 personal mooring, Association common area, etc. =5 : Total Number of Slips on Privately-Owned Lands, Add lines 1 through 3 2014/2015 GROSS INCOME REPORTING FORM Lessee: n100sh dnwry 13C°C Instrument #: 7/ w74, 5/ Direct Income Indirect Income Allincome 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 May 2014 |$ /3, 5%80.20 S ¢ 151/ June 2014 $/3 5%82. 00 $ /05, 635.47 July 2014 1573 562, op $ 123 £39.47 August 2014 |$/3,5%0, 0p s 73 9 o7 September 2014 $ /3582, 00 S Hp 53417 October 2014 15/3 592.00 S 4392 31 November 2014 $ )3 22,0 S s oY December 2014 |$/3 59000 s 944899 January 2015 $/8 592,00 $ 7 642, Ol February 2015 193 599 0p $ 936,55 March 2015 5)3 562,00 s 3y 2.7 April 2015 |s/3 s¢0.0p § 59530 36 TOTALS S Jbd, 9900 s 578 535 4/ Every month must be filled out even if income for the month is zero. "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 memberships, and other similar transactions. 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 OFFICE OF OPERATIONS 3900 COMMONWEALTH BOULEVARD, MS #550 TALLAHASSEE, FLORIDA 32399-3000 (850) 245-2616 CERTIFICATION Instrument No. b0, 65, Lessee Name: OUALL05A_Qgurzred BCC Biling Address 3/00 A/ [insor ST, SuzzE 302 City/State/Zip Qlsrtan /2. 3353 ¢ Telephone: (B5D ) £89- 5770 (Please provide area code) E-Mail Address 20 ) (5D OABY 0p5AAY . (4G Facility Address: 390 Pred 2O City/County/Zip: 7 Jidh 25 ‘ 4/3.25 I, 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 Wet Slip Information Forim and the Gross Income Reporting Forin 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 ali the terms and conditions of the sovereignty submerged lands lease; (3) | 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) OR Produced Identification Type of identificaiton produced Notary Signature Commission Expires REVENUE FIGURES FOR OKALOOSA ISLAND PIER FROM MAY 2014 - APRIL 2015 MONTH FISHERS SR FISHERS | CHILD FISHERS PASS WALKERS TOTALS May, 2014 $33,681.47 $2,244.04 $1,725.71 $1,113.18] $22,393.71| $61,158.11 June, 2014 $51,079.05 $2,522.02 $6,366.86 $2,275.92| $43,391.42| $105,635.27 July, 2014 $57,545.60 $2,092.04 $8,532.78 $1,207.51| $54,260.56] $123,638.49 August, 2014 $33,325.64 $1,214.20 $4,636.53 $677.00| $34,115.67| $73,969.04 September, 2014 $17,940.37 $1,956.85 $1,117.88 $457.54| $19,058.50] $40,531.14 October, 2014 $17,074.22 $1,433.39 $2,400.08 $939.03| $19,545.59| $41,392.31 November, 2014 $3,708.37 $373.03 $171.10 $0.00 $3,848.54 $8,101.04 December, 2014 $3,864.27 $465.89 $477.23 $179.24 $4,682.36 $9,668.99 January, 2015 $2,497.11 $405.82 $288.32 $226.40 $4,224.36 $7,642.01 February, 2015 $2,623.43 $600.74 $202.09 $655.64 $5,284.68 $9,366.58 March, 2015 $14,794.50| $1,580.11 $2,380.02 $2,071.65| $17,085.89] $37,912.17 April, 2015 $28,368.97 $1,850.81 $2,889.23 $1,027.90] $25,383.65] $59,520.56 TOTALS $266,503.00] $16,738.94 $31,187.83 $10,831.01| $253,274.93 $578,535.71 Poviden BY PLEC AGOCANES S/6/s5.