Backup Documents 11/15/2016 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATUR
1 6 Ei3
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. Elizabeth Hernandez Community and Human
4,
Services 01/07/4
/Cf
2. Jennifer Belpedio County Attorney Office ,) it 1151)(,0
3. BCC Office Board of County -F
Commissioners �((c�-/ \\\tto\`te
4. Minutes and Records Clerk of Court's Office '--PON l(h6(1.6 31
51*
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 Elizabeth He andez/CHS Phone Number 252-2338
Contact/ Department
Agenda Date Item was 11/15/16 Agenda Item Number /
Approved by the BCC / 3
Type of Document Release of Lien Number of Original
Attached Documents Attached 2
PO number or account Two Letters of Authorization to use Habitat
number if document is for Humanity Recording Account
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? S—kg 13 a v_4(1,_.4 EH
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 H
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 EH
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 EH
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 11/15/2016 and all changes made during EH
the meeting have been incorporated in the attached document. The County 4 .
Attorney's Office has reviewed the changes,if applicable. rAeA
9. Initials of attorney verifying that the attached document is the version approved by the - s
BCC,all changes directed by the BCC have been made, and the document is ready for th= ', :2- ,,,
Chairman's signature. iA
1: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
1603
INSTR 5336239 OR 5335 PG 1249
RECORDED 11/18/2016 12:23 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by:Elizabeth Hernandez
REC$10 00
Collier County
Community &Human Services Division
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 Impact
Fee Agreement executed by Habitat for Humanity of Collier County, Inc. to Collier County,
recorded on 02/14/01 in Official Records Book 2777 Page 2069, of the Public Records of Collier
County, Florida, in consideration of$7,698.82 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, more particularly
described as follows:
LOT 12,BLOCK 14,NAPLES MANOR,UNIT 1,AS RECORDED IN PLAT
BOOK 3,PACE SI,OP THE PUBLIC RECORDS OP COLLIER COUNTY FLORIDA.
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
j///SP , 2016 Agenda Item Number
ATTEST: BOA r D OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, CLERK OF if S LIER COUN, Y,ELORIDA
By: 1. -11 B • jjfjjl
Attest as tustii
RK Don a Fiala,Chairman
Apr._ I• 4nd legality:
lor%
Jennifer A. Belpe.
Assistant County Attorney
0) 0
044
RI NEScToRR5a7z.17 5335 1603
27,1,,,,,l'pAGEs 1
DWIGHT E BROCK CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by:Elizabeth Hernandez REC$10 00
Collier County
Community&Human Services Division
3339 E.Tamiami Trail, Building II,#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 Impact
Fee Agreement executed by Imrnokalee Habitat for Humanity,Ine. to Collier County,
recorded on 11/07/97 in Official Records Book 2361 Page 0871,of the Public Records of Collier
County, Florida, in consideration of$6,169.52 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, more particularly
described as follows:
LOT 2 OF BLOCK 13, NAPLES MANOR LAKES.ACCORDING
TO THE PLAT BOOK l'HEREOF,AS FtECORDIM IN PLA't BOOK
3,AT PAGE 86,OF THE PUBLIC RECORDS OF COLLIER COUNTY
FLORIDA.
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 -
/037/6 2016,Agenda Item Number /6/D. 3,
ATTEST: BOAR OF COUNTY COMMISSIONERS
DWIGHT E.I3ROCK,CLERK. OF Cf IER COUNT ,FLORIDA
By: I lig it C • By:
RK
Attest as t. vdr - • Donn. Fiala,Chairman
AppAntittlfed3WYled legality:
Jen er A, elpedio
v‘LO
Assistant County Atto y arg) \
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