Backup Documents 12/08/2015 Item #16D 5 Th lige( r4tv[1(
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO Q
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 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 Community and Human awk 12/08/15
Services
2. County Attorney Office County Attorney Office , 1-2.1g i5
3. BCC Office Board of County 7
Commissioners \4/ 1Z�`6�t5
4. Minutes and Records Clerk of Court's Office
t4 ? Iic 39p/I-1
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 Klop /CHS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 12/08/15 Agenda Item Number 16.D.5
Approved by the BCC
Type of Document Release of Lien Number of Original l
Attached Documents Attached
PO number or account 1-Habitat for Humanity account H-1500
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? 5'M P o WK
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
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
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 12/08/15 and all changes made during WK lr
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 he �t
Chairman's signature. 1 �— ``
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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
1605
Ann P. Jennejohn
From: Ann P.Jennejohn
Sent: Monday, December 28, 2015 1:42 PM
To: Klopf, Wendy
Subject: Item #16D3, #16D5 D8 (12-8-15 BCC Meeting)
Attachments: Items#16D3, #16D5 D8 12-8-15 BCC Meeting recorded documents.pdf
Hi Wendy,
Copies of the recorded Releases of Lien (Item #16D3 and #16D5) and the
Satisfactions of Mortgage under Agenda Item #16D8, that were approved by the
Board during their meeting on December 8, 2015 are attached for you.
There's a receipt for the $$ recording charges behind each recorded document.
Thank you!
Ann Jennejohn, Deputy Clerk
Clerk of the Circuit Court
Clerk to the Value Adjustment Board
Collier County Board Minutes & Records Dept
1
1605
INSTR 5205069 OR 5222 PG 1857
RECORDED 12/10/2015 2:17 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by:Wendy Klopf REC$10.00
Collier County Community and Human Services
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
3399 E. Tamiami Trail, Naples, Florida 34112, the owner and holder of a certain Impact Fee
Agreement executed by Habitat for Humanity of Collier County, Inc. to Collier County,
recorded on 03/28/2003 in Official Records Book 3251, Page 0129, of the Public Records of
Collier County, Florida, in consideration of$6,082.98, 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, described in the
aforementioned Impact Fee Agreement.
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 -
g , 2015, Agenda Item Number /t b S .
o--
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA
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By, �°1 s� 46, By: ��
+ ► 1' •uty Clerk Tim Nance, Chairman
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Att @S '111a11
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Approved as to form and legality:
Jennifer A. Belpe
Assistant County Att ey