Backup Documents 11/10/2015 Item #16A21 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 A 21
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 b received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP .e(.:YCtiinc\ 11It+O
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is alleady 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 KN 11/10/15
4. BCC Office Board of County
Commissioners /S/ , \`\dVS
5. Minutes and Records Clerk of Court's Office
.gym t5 2:33?M
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 E.Villarre 1,Code Enforcement Phone Number 252-2444
Contact/ Department
Agenda Date Item was 11/10/15 Agenda Item Number 16-A-21
Approved by the BCC
Type of Document Release and Satisfaction—Bahrami Number of Original One
Attached Documents Attached
PO number or account
number if document is 111-138911-649030
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable colu • ._•• hever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signa ure? STAMP OK KN
2. Does the document need to be sent to another agency for a'I. al signator- If yes, KN
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 KN
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 KN
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 KN
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 KN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KN
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 11/10/15 and all changes made during KN
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 KN
BCC,all changes directed by the BCC have been made,and the document is ready for ,e
Chairman's signature. `/:N
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
*** INSTR 5194223 OR 5213 PG 1136 RECORDED 11/12/2015 9:24 AM PAGES 1 *** 1 6 A 2 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT, COLLIER COUNTY FLORIDA
REC $10.00
This Instrument Prepared By:
Jeff Wright
Code Enforcement Division
2800 North Horseshoe Drive
Naples, FL 34104
(239)252-2440
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA is the owner and holder of a certain lien against all real and
personal property owned by:
\--' =Responde
The lien was recorded on Julji 22; -21-4Q Official Records B ok 4818, Page 3947, in the
Official Records of Collier Co inty/St Flor a.-Tie lien secur s the principal sum of ninety-
one thousand eight hundred n' _. l d ' ' e5 nts\($91,809.89), plus accrued
interest and penalties, if an , a d O.. e e ain bfl g ti galnst real property situated in
Collier County, Florida.
1
Collier County, a political su fi,y, ion of the State o flori4a,)ye cecution of this Release and
Satisfaction of Lien, ackn w es payment all, pprpped' by the Board of County
Commissioners as satisfaction f'3h \lien and hereby can fs releases said lien.
0 - ''°
The Clerk of the Circuit Court is her ' ei to =t `q d-triis Release and Satisfaction of Lien
in the Official Records of Collier County, a. ..a:AdAekilOwledge that the lien ceases to exist.
ATTEST BOARD OF COUNTY COMMISSIONERS
DWIGHT E.-BROCK, Clerk COLLIER COUNTY, FLORIDA
By: 'i^ _. �ssw�=V By: ‹,a4e4e.._
: . ? '�_,.. , -.D-pu'r Jerk Tim Nance, Chairman
Date:t a.` -104-015 Date: 1.1 k1aV5
Attest a`s to- hairman `��`
gaa11 •SU,1," .
AIynPPTb�E0� g'toform and legality
-- _,,I,
Kevin Noell
Assistant County Attorney
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