Backup Documents 02/11/2014 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT � J (9 L)-f
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SI
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County ttorney 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
1. Wendy Klopf HHVS 02.11.14
2. Jennifer Belpedio County Attorney Office
�fl3 211114
3. BCC Office Board of County
Commissioners 2-\\- \Vs\
4. Minutes and Records Clerk of Court's Office
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 Wendy Klopf/HHVS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 02.11.14 V Agenda Item Number 16.D.2
Approved by the BCC
Type of Document Release of Lien V Number of Original 1
Attached Documents Attached
PO number or account 1 checks for 10.00 to pay for recording
number if document is
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? WK l/
2. Does the document need to be sent to another agency for additional signatures? If yes, -NA N 1-4
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 WK
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 NA- N
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 WK
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 WK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
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 02/11.14 and all changes made during WK
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the WK
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
1602
INSTR 4945931 OR 5009 PG 1485
RECORDED 2/17/2014 2:56 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC$10.00
Prepared by:
Collier County
Housing,Human&Veterans Services Dept
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 Impact
Fee Agreement executed by Habitat for Humanity to Collier County, recorded on December
3, 2001 in Official Records Book 2935, Page 0402, of the Public Records of Collier County,
Florida, in consideration of$7,6 98_82 , 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, upon the aforementioned lien.
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 -
o^
/ / , 2014,Agenda Item Number 42 ,O o, .
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER Co, TY, � ORIDA
By LQ. GC . B • ;Deputy Clerk
Clerk
Attest� s to Comm.Torn Henrqng
signature only,, Chairman
Approved for form and legality:
-e
Jennifer A. Belpedi
Assistant County Attorney op u>s