Backup Documents 03/25/2014 Item #16C1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP ✓
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 Attorney 0 ice
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney ice 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.
2.
3. County Attorney Office County Attorney Office
-2_A\
4. BCC Office Board of County
Commissioners Y , 7)\7_f_.--)\A
5. Minutes and Records Clerk of Court's Office
-TM 31241 10'. 5,401
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 Pam Callis,Utilities Finance Phone Number 239-252-2359
Contact/ Department
Agenda Date Item was 3/25/2014- Agenda Item Number dtaez4-
Approved by the BCC
Type of Document Satisfaction of Notice of Promise to Pay Number of Original 1
Attached and Agreement to Extend Payment of Water Documents Attached
and/or Sewer System Impact Fees
PO number-eiccount
nun b if do uc nt is 408-210152-649030
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? SS
2. Does the document need to be sent to another agency for additional signatures? If yes, SS
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 SS
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 SS
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 SS
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 SS
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip SS
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 3/25/14 (enter date)and all changes SS
made during 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 t, ��
BCC,all changes directed by the BCC have been made,and the document is ready r the
Chairman's signature. \ C'
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revise. . ..! • . ed 11/30/12
This Instrument prepared by: 16 C 1
Jennifer A. Belpedio
Assistant County Attorney INSTR 4962202 OR 5021 PG 3440
Office of County Attorney RECORDED 4/1/2014 10:00 AM PAGES 2
3299 East Tamiami Trail, Suite 800 DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Naples, Florida 34112 COLLIER COUNTY FLORIDA
(239)252-8400 REC$18.50
SATISFACTION OF NOTICE OF PROMISE TO PAY AND AGREEMENT TO EXTEND PAYMENT OF
WATER AND/OR SEWER SYSTEM IMPACT FEES
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS,
COLLIER COUNTY, FLORIDA, AS THE GOVERNING BODY OF COLLIER COUNTY AND AS
EX-OFFICIO THE GOVERNING BOARD OF THE COLLIER COUNTY WATER-SEWER DISTRICT, was the
owner and holder of a certain Agreement with the following:
RUSSELL H. OWEN, JR.
Whose mailing address is
170 Pine Key Lane
Naples, Fl. 34114-8417
Bearing the date of the 12th day of May 2005, recorded in Official Record Book 3837, Page(s) 3403-3407,
in the Office of the Clerk of the Circuit Court of Collier County, State of Florida, which Agreement imposes a lien
on the subject real property. The Lien secures the principal sum of One Thousand Two Hundred Thirty Dollars and
Zero Cents ($1,230.00) plus accrued interest and penalties, if any, and imposes certain obligations against real
property situated in Collier County, Florida, described as follows:
UNIT 13, WEST WIND MOBILE HOME ESTATES, A CONDOMINIUM, ACCORDING TO
THE DECLARATION OF CONDOMINIUM THEREOF RECORDED IN OFFICIAL RECORD BOOK
630, PAGES 1883 THROUGH 1932, INCLUSIVE, OF THE PUBLIC RECORDS OF COLLIER
COUNTY, FLORIDA, AS AMENDED, TOGETHER WITH AN UNDIVIDED INTEREST IN THE
COMMON ELEMENTS OR SURPLUSES ACCRUING TO SAID PROPERTY.
SUBJECT TO TAXES FOR THE YEAR 2002 AND SUBSEQUENT YEARS, RESTRICTIONS,
RESERVATIONS, COVENANTS AND EASEMENTS OF RECORD, IF ANY.
FOLIO NUMBER: 81620520002
Collier County, a political subdivision of the State of Florida, and the Collier County Water-Sewer District,
a political subdivision of the State of Florida, hereby acknowledges receipt of payment in full satisfaction of the Lien
and hereby cancels the Lien.
The Clerk of the Circuit Court is hereby directed to record this Satisfaction of Lien in the Official Records
of Collier County, Florida, to acknowledge that the Lien ceases to exist.
16Ci
IN WITNESS WHEREOF, the Board of County Commissioners of Collier County, Florida, and as
Ex-Officio the Governing Board of the Collier County Water-Sewer District, acting through its Chairman, directs
execution and recording of this Satisfaction of Lien, by action of the Board this 2S k\r-\ day of
\--k_ccv- , 2014.
ATTEST: �:���
DWIGHTt. BROCI , CLERK BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA, AS THE
li,
GOVERNING BODY OF COLLIER_ -• ,; • ; COUNTY AND AS EX-OFFICIO THE
. _Attest as to C I y Clerk GOVERNING BOARD OF THE COLLIER
Si nature only: COUNTY AT R-SEWER DISTRICT
Approved as to form and legality:
Jennifer A. Belpedi TOM ENNING, A • IRMAN
Assistant County Attorney