Backup Documents 12/09/2014 Item #16F2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 F
, 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 Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be receivedecin
the County Attorney Office no later
than Monday preceding the Board meeting. ..01 C /
**NEW** ROUTING SLIP [L/l`
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is a ady 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
4. BCC Office Board of County 1i4
Commissioners VO-4S/ 141\A
5. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
UVB 1,1 to 14 1L*
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 (' ^7 Phone Number
Contact/ Department ��Wri `� \ rM.-1
Agenda Date Item was Agenda Item Number
Approved by the BCC \-).\�\\M 1Co, c,
Type of Document ` Number of Original
Attached 'K4\ S 4 cst- `-` Documents Attached
PO number or account
number if document is
to be recorded cA�� c�� �3
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
I. Does the document require the chairman's original signature?
2. Does the document need to be sent to another agency for additional signatures? If yes,
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
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's
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
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
signa,re and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
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. N mare of your deadlines!
8. The document was approved by the BCC onAnter date)and all changes 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 t
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
16 F 2
This instrument prepared by:
INSTR 5062665 OR 5103 PG 1545
Amy Patterson RECORDED 12/12/2014 2:20 PM PAGES 2
Collier County Growth Management Division DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
2800 North Horseshoe Drive COLLIER COUNTY FLORIDA
Naples,Florida 34104 REC$18 50 INDX$1.00
(239)252-5721
RELEASE OF LIEN
KNOWN ALL MEN BY THESE PRESENTS: That Collier County, whose post office address
is 3301 East Tamiami Trail, Naples, Florida, 34112, the former owner(s) and holder(s) of a
certain Impact Fee Agreement executed by Daniel Castro and Yolanda Ocanas and Habitat
for Humanity to Collier County, executed on August 4, 2005 and recorded in Official
Records Book 3861, Page 1409 of the Public Records of Collier County, Florida, hereby
does release from lien the real property described in Exhibit"A" (attached), currently owned by
Jean Claude Jocirin and Marie Thase Dathelus.
The undersigned is authorized to and does hereby release this lien as to the whole of the above-
described real property and consents to this lien being discharged of record.
-141
Dated this day of -c C f Wt b e r , 2014.
ATTEST: ,,. BOARD OF COUNTY COMMISSIONERS
DWIGHT B , Clerk COLLIER COUNTY,FLORIDA
By: ,, t ' ` ,4tei_OF dam- ,s ____
Attest alto Chairman s°DFt' y C i TOM HENNI G, Chai
/
signature only.
Appricve. it y orm
and l.'::. •'uf. ciency:
4
b.
Jeffre . L11,1 ow
Count ,' tt rney
16F 2
EXHIBIT "A"
LEGAL DESCRIPTION
OWNERSHIP
ADDRESS
1260 Allegiance Way, Immokalee Florida 34142
Lot 40, Independence Phase II, as recorded in Plat Book 43,Pages 64-66 of the
Public Records of Collier County, Florida