Backup Documents 10/28/2014 Item #16D 5 i ' c 'c. < < /3
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO�4D 5
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGN
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 routinglines#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 44r /6/2041
Services
2. County Attorney Office County Attorney Office
3. BCC Office Board of County 'T
Commissioners \f q\c/1 i.4`30.V.4
4. Minutes and Records Clerk of Court's Office
t0(30(iti 3:3vprn
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 Sp cialist, Phone Number 239-252-2338
Contact/ Department Community and Human Se ces
Agenda Date Item was October 28,2014 Agenda Item Number 16.D.5
Approved by the BCC
Type of Document Satisfaction and Release of Lien Number of Original 1
Attached Documents Attached
PO number or account
number if document isRRecording Fee will be billed to Account# 107-138920-649030
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) 9pplicable)
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 t/
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 V
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 V
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 10/28/14 and all changes made during MM-
the meeting have been incorporated in the attached document. The County No
Attorney's Office has reviewed the changes,if applicable. Ch
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 o _09)�
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
1 6 0 5
INSTR 5048508 OR 5091 PG 2861
RECORDED 11/4/2014 3:58 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by:Mandy Moody REC$10.00
Collier County
Community and Human Services Dept
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 Sophia Fernandez to Collier
County, recorded on February 2,2007 in Official Records Book 4178, Page 0919, of the Public
Records of Collier County, Florida, in consideration of $8,712.69, 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:
Unit 104, Building 9, Botanical Place, A Condominium, according to the declaration of
condominium thereof recorded in the official records Book 3933, Page 2655, 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.
Dated this a g+day of 0c L , 2014.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA
By: ' ' `+. C • Byy--dr‘•-.1
Deputy Clerk TOM HENNING, RMAN
Attest as a FA• rman s
signature only.:
Approved as to form and
legality:
Jennifer A. Belpedio •
Assistant County Attorney 03)
C6 43'