Backup Documents 01/13/2015 Item #16D 8 1-67 d
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ORIGINAL DOCUMENTS CHECKLIST & ROUTINGL i.
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TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT T� �+
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 In'tials Date
1. Peggy Hager Community and Human
Services ///2—//-5
2. County Attorney Office County Attorney Office s q, --
3. BCC Office Board of County `T(
Commissioners \ / A ,\l5
4. Minutes and Records Clerk of Court's Office
1 lf[51(5 14'3(PM
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 January 13,2015 �� Agenda Item Number EDS
Approved bythe BCC 4
Type of Document ' Number of Original
Release of Lie
n
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?
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. Cha s
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 <V3-97
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
1613 8
INSTR 5075161 OR 5113 PG 2154
RECORDED 1/21/2015 10:06 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by:Mandy Moody COLLIER COUNTY FLORIDA
Collier County REC$10.00
Community and Human 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 and holder of a certain Impact Fee
Agreement executed by Jubilation Development Corporation to Collier County, recorded on
01/10/03 in Official Records Book 3194, Page 0699, of the Public Records of Collier County,
Florida, in consideration of $6,082.98, receipt of which is hereby acknowledged does remise,
release, quitclaim, exonerate and discharge from the lien and operation of the said agreement,
that certain portion of the premises conveyed by said lien, described in the aforementioned
Impact Fee Agreement.
The undersigned is authorized to and does hereby 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.
This Release of Lien was approved by the Board of County Commissioners on -
Janaar j 13 , 2015, Agenda Item Number 1L0- D. .
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT'E. BROCK, Clerk COLLIER COUNTY, FLORIDA
yrgl:I�; O
By 1 .., OC • By:
Ch7 , Deputy Clerk Tint Nance , Chairman
signature only,M ;
z.
Approved as to form and
legality:
Jennifer A. Bel'-.• ►
\\
Assistant County • torney OS>) U1'
,v
1 6 0 8
INSTR 5075153 OR 5113 PG 2146
RECORDED 1/21/2015 10:06 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by:Mandy Moody COLLIER COUNTY FLORIDA
Collier County REC$10.00
Community and Human 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 and holder of a certain Impact Fee
Agreement executed by Arnold Augustin to Collier County, recorded on 05/12/03 in Official
Records Book 3289, Page 0306, of the Public Records of Collier County, Florida, in
consideration of $11,602.98, receipt of which is hereby acknowledged does remise, release,
quitclaim, exonerate and discharge from the lien and operation of the said agreement, that certain
portion of the premises conveyed by said lien, described in the aforementioned Impact Fee
Agreement.
The undersigned is authorized to and does hereby 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.
This Release of Lien was approved by the Board of County Commissioners on -
-jtki IL". t j , 2015,Agenda Item Number '1(o 0,
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROOK, Clerk COLLIER COUNTY, FLORIDA
7 B B
F: . '� ►`
a bity Clerk Tim Nance , Chairman
Attest 'wt . Ors
s natu "fit
�`14 .
Approved as to form and legality:
Jennifer A. Belp dl a
Assistant County rney (}j NN
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