Backup Documents 10/27/2015 Item #16D1 4D)601,14-
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO /,meq
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE 10 /
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 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. Community& Human
Services (CHS) Division
2. County Attorney Office County Attorney Office
iQ IA3i1s•
3. BCC Office Board of County /1,
Commissioners `�`vr�S( t 1\\s
4. Minutes and Records Clerk of Court's Office V�—rn 1pllam$IIS -d;
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 Rosa Munoz,CHS Phone Number 252-5713
Contact/ Department
Agenda Date Item was October 27,2015 ✓ Agenda Item 16D1
Approved by the BCC Number
Type of Document Termination and Extinguishment-Declaration of Number of Original 2
Attached Covenants for Farmworker Village Public Documents
Improvements Attached
PO number or account
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? CU/2l6 RM
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 RM
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 RM
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 RM
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip RM
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 10/27/15 and all changes made RM
during the meeting have been incorporated in the attached document. The Countya .
Attorney's Office has reviewed the changes,if applicable. f
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.
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
1601
INSTR 5189267 OR 5209 PG 182
RECORDED 10/29/2015 1:34 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by: COLLIER COUNTY FLORIDA
Jennifer A. Belpedio, Esq. REC$10.00
Record and Return to:
Collier County Attorney's Office
3299 East Tamiami Trail, Suite 800
Naples, FL 34112
THIS SPACE FOR RECORDING
TERMINATION AND EXTINGUISHMENT
OF
DECLARATION OF COVENANTS, CONDITIONS, AND RESTRICTIONS
FOR
FARMWORKER VILLAGE PUBLIC IMPROVEMENT
KNOW ALL MEN BY THESE PRESENTS:
That the undersigned does hereby terminate and extinguish that certain Declaration of
Restrictions for Farmworker Village, dated August 5, 2008, and recorded in Official Records
Book 4386 at Page 0700 of the Public Records of Collier County, Florida, upon the following
described property, to wit:
It is bound by State Road 29, Section 11, Township 47, Range 29 that portion of NW 1/4 of NW
1/4 lying South Westerly of former ACLRR R/W & that part of W3/4 and NW 1/4 of NW 1/4
Lying North Easterly.
Collier County Tax Folio Number: 00137120002
Address:
1800 Farmworker Way
Immokalee, FL 34142
IN WITNESS WHEREOF, the undersigned has caused these presents to be executed on the
dates set forth below.
ATTEST:
BOARD OF COUNTY COMMISSIONERS
DWIGHT E BROCK, Clerk COLLIER COUNTY,FLORIDA
fi 44. By: (
ttest as to ( irtttan`SDeputy Clerk TIM NANCE, CHAIRMAN
•
Approved'.tor�rm &legality:
Jennifer A. Belpedio
Assistant County Attorney 5
[15-SOC-00671/1208790/1] %,C o\1 I