Backup Documents 01/13/2015 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING D
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT i
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date S
1. Peggy Hager Community and Human
Services �'+IA
2. County Attorney Office County Attorney Office j
3. BCC Office Board of County i k4
Commissioners \f t$, t\k 5\ s
4. Minutes and Records Clerk of Court's Office
t1C5(t3 1-1..3Ip1r
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Mandy Moody, Grant Support Specialist, Phone Number 239-252-2338
Contact/ Department Community and Human Services
Agenda Date Item was ' '� Agenda Item Number
Approved by the BCC January 13,2015 ) 16.D.1
Type of Document Release of Lien Number of Original
Attached Documents Attached
PO number or account
number if document is Recording Fee paid by check attached Account#
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? MM-
Stamp
ok
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be MM
signed by the Chairman,with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the MM
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's MM
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 01/13/15 and all changes made during MM-
the meeting have been incorporated in the attached document. The County No
Attorney's Office has reviewed the changes,if applicable. Ch. :es
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the ,
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1601 410
INSTR 5075160 OR 5113 PG 2153
RECORDED 1/21/2015 10:06 AM PAGES 1
Prepared by: Mandy Moody DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Collier County COLLIER COUNTY FLORIDA
REC$10 00
Housing, Human&Veteran Services
3339 E. Tamiami Trail, Building H, #211
Naples,FL 34112
THIS SPACE FOR RECORDING
RELEASE OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That Collier County, whose post office address is 3299 E.
Tamiami Trail, Naples, Florida 34112, the owner(s) and holder(s) of a certain Lien Agreement for Deferral of
100% of Collier County Impact Fees for Owner Occupied Affordable Housing Dwelling Units (the "Impact Fee
Lien.") executed by Edmundo Auzo to Collier County, recorded on September 25, 2006 in Official Records
Book 4111, Page 0468, of the Public Records of Collier County, Florida, in consideration of$8,946.77, receipt
of which is hereby acknowledged does satisfy, remise, release, quitclaim, exonerate and discharge the Impact
Fee Lien against the premises conveyed by said Impact Fee Lien and more particularly described as
follows:
Unit 103, Building 9, Botanical Place, A Condominium, according to the declaration of condominium.
thereof recorded in the official records Book 3933, Page 2655, of the Public Records of Collier County,
Florida.
The undersigned is authorized to and does hereby satisfy and release this Lien with respect to the above-named
property and consents to this Lien being forever discharged of record with respect to said property.
ATTEST: e BOARD OF COUNTY COMMISSIONERS OF COLLIER
DWIGHTfi B .ROC'K,. ERK COUNTY, FLORIDA
7-e
11,14 _ma �►-_�. C.,• Bye
Attest'>�
.�' �, +�a: 'It -puty Clerk TIM NANCE , CHAIRMAN
signature only.
Dated: akt u[ 706 Approved as to form and legality:
( )
•
Jennifer AT:elpedio \4
Assistance County Attorney g,\
[14-SOC-00632/1132963/1]