Backup Documents 04/28/2015 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP tl "
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 orq�y
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney i I
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. Peggy Hager Community and Human I
Services •'I y ZZ 1 S
2. County Attorney Office County Attorney Office
3. BCC Office Board of County "INIC -->
Commissioners \f\/5 4.\\ VS
4. Minutes and Records Clerk of Court's Office
1-e, 141345- ID: IC
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 Hum rvtce
Agenda Date Item was Agenda Item Number
April 28,2015 .-
Approved by the BCC • ' /402 /
Type of Document Release of Lien > Number of Original 1 ---
Attached Documents Attached
PO number or account
number if document is Recording Fee paid from Habitat account. Account# H05100
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 04/28/15 and all changes made during MM000-
the meeting have been incorporated in the attached document. The County No '.'- $
Attorney's Office has reviewed the changes,if applicable. Chan. - $ L
9. Initials of attorney verifying that the attached document is the version approved by the e r
BCC, all changes directed by the BCC have been made, and the document is ready for the t* -W
Chairman's signature. i
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
1 6 0 4
INSTR 5115931 OR 5146 PG 2155
RECORDED 5/1/2015 9:29 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by: Mandy Moody COLLIER COUNTY FLORIDA
Collier County Community and Human Services REC$10.00
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 Dollie Gallegos to Collier County, recorded on 01/30/2008 in Official Records Book 4325,
Page 2032, of the Public Records of Collier County, Florida, in consideration of$15,553.15, 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:
Lot 14, Liberty Landing, according to the plat thereof, as recorded in Plat Book 47, Page 71 through 73,
inclusive, 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: BOARD OF COUNTY COMMISSIONERS OF COLLIER
DWIGHT E. BROOK,VVERK COUNTY, FLORIDA
b ,ti vk B 1 , C.C._
lIeputyClerk TIM NANCE, CHAIRMAN
Attest as to ,1airnlan s
'lgnature only.
Dated: `I, 1 aDi 1 ''.-- Approved as to form and legality:
(SEAL)
'''%`7;)0_,R.9,. .......•—•
Jennifer A. Belpedio
Assistance County Atto y 9 4\`