Backup Documents 07/07/2015 Item #16C3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR Site�*!
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forty 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
1.
2.
3. County Attorney Office County Attorney Office r_ 1ZciIS
4. BCC Office Board of County b
Commissioners V�`��/ —ti,q`1S
5. Minutes and Records Clerk of Court's Office 7iY\ rliS(15 t4:31fi,‘
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 dditional or missing information.
Name of Primary Staff Pam Callis, tilties Finance Phone Number 252-2359
Contact/ Department
Agenda Date Item was 7/7/2015 Agenda Item Number 16-C-3
Approved by the BCC
Type of Document Satisfactions of Notice of Promise of Pay Number of Original x '
Attached and Agreement Documents Attached
PO number or account 413-263613-649030
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? S , o Val LK
2. Does the document need to be sent to another agency for additional signature? If yes,J . LK
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed LK
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's LK
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 LK
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 LK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip LK
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 07/7/15 (enter date)and all changes LK
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 the
BCC, all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
***PLEASE NOTE: Clerks Office: Do Not provide a copy of the recorded ocuments***
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
This Instrument prepared by: INSTR 5147292 OR 5173 PG 1482
Jennifer A. Belpedio RECORDED 7/10/2015 2:23 PM PAGES 2 -
Assistant County Attorney DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Office of County Attorney COLLIER COUNTY FLORIDA
REC$18.50
3299 East Tamiami Trail, Suite 800
Naples,Florida 34112
(239)252-8400 1 6 C 3
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:
PATSY BOUSFIHA now known as PATSY D ARRUDA
Whose mailing address is
160 Pine Key Ln
Naples, Fl. 34114-0000
Bearing the date of the 16th day of March 2005, recorded in Official Record Book 3788, Page(s)3910, 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 NO. 14, WEST WIND MOBILE HOME ESTATES, A CONDOMINIUM, ACCORDING TO THE
DECLARATION OF CONDOMINIUM THEREOF RECORDED IN O. R. BOOK 630, PAGES 1863 THROUGH
1932,INCLUSIVE, OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA.
TOGETHER WITH A 1982 BRIGADIER 24' X 56' MOBILE HOME. IDENTIFICATION NUMBER 3B-
56-40846 A AND B INCLUDING ALL ATTACHMENTS AND IMPROVEMENTS THEREOF.
SUBJECT TO THE TERMS AND CONDITIONS OF THE AFOREMENTIONED DECLARATION OF
CONDOMINIUM,EASEMENTS,RESTRICTIONS AN RESERVATIONS OF RECORD.
SUBJECT TO TAXES FOR THE YEAR 1995 AND SUBSEQUENT YEARS. PROPERTY TAX ID:
FOLIO#8152056000/4.
THIS IS NOT THE HOMESTEAD PROPERTY OF THE GRANTOR NOR CONTIGUOUS THERETO.
FOLIO NUMBER: 81620560004
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.
1603
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-1+V, day of---1‘-&--•\ ,2015.
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ATTEST: • cr�.
dl11i11f�Rj
DWIGHT E. BRaCIK,.C' RK BOARD OF COUNTY COMMISSo ��Ik „ `r,
COLLIER COUNTY,FLORIDA ;THE• '
r ¢ GOVERNING BODY OF COL) •` •
CtudtA 4" .14 0 C , COUNTY AND AS EX-OFFI( C 'TH
cAlttesti'as to Ch
¶'" erk GOVERNING BOARD OF THEOLLIER a ;.
fi�tt'' COUNTY WATER-SEWER DtS`ijkIC�t ,.^
Apr 9�lol •m and legality: ,. ', .;.
ild'�tl:lli:tll�lti\ '
Jenni er A.Belp • ‘4? TIM NANCE, CHAIRMAN
Assistant County Attorney C4
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