Backup Documents 10/24/2017 Item #16F 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 F 1
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 received Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP ' `Ltp
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is 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 JAK 10/24/17
4. BCC Office Board of County C
Commissioners 45'
5. Minutes and Records Clerk of Court's Office 1 m (O(al
� 2' 10m
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 mi ing information.
Name of Primary Staff Paula Fleishm n,Impact Fees Phone Number 252-2924
Contact/Department
Agenda Date Item was 10/24/17 Agenda Item Number 16-F-1
Approved by the BCC
Type of Document Release of Lien-Armand Number of Original One
Attached Documents Attached
PO number or account 107-138920-649030
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 signa • AMP OK JAK
2. Does the document need to be sent to another agency fo additional signature . If yes, JAK
provide the Contact Information(Name;Agency;Address; ' :•= :• attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAK
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 JAK
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 JAK
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 JAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip JAK
should be provided to the County Attorney Office at the time the item is input into
MinuteTraq. 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 10/24/17 and all changes made during JAK
the meeting have been incorporated in the attached document. The County al
Attorne 's Office has reviewed the chan les,if as licable. _...gro
9. Initials of attorney verifying that the attached document is the version approved by the J
-011
BCC,all changes directed by the BCC have been made,and the document is ready fo the \ �,CC
Chairman's signature. t"'
[04-COA-01081/1344830/111:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revi - . ..05,Revised 2.24.05;
Revised 11/30/12
16F 1
RELEASE OF LIEN
KNOWN ALL MEN BY THESE PRESENTS: That Collier County, whose post office address
is 3299 East Tamiami Trail, Naples, Florida, 34112, the owner(s) and holder(s) of a certain
Agreement for Deferral of 100% of Collier County Impact Fees- Immokalee Residential Impact
Fee Deferral Program executed by Junie Armand and Habitat for Humanity to Collier
County, recorded on March 9, 2005, in Official Records Book 3748, Pages 2004 et seq. of the
Public Records of Collier County, Florida, hereby does release from lien the real property
more particularly described as follows:
Parcel ID: 51677511023 - Lot 55, Independence Phase I, as recorded in Plat Book 41,
Pages 44 -46 of the Public Records of Collier County, Florida.
The undersigned is authorized to and does hereby release this Lien with respect to the above-
described real property and consents to this lien being discharged of record.
Dated this ZA-kArk day of ,�d�vr- 2017.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT,E. BROOK,Clerk COLLIER COUNTY, FLORIDA
411,•
B ,. �/ B //
y• �Ii �� y I�L.i ��
,_.-""".«-•._ .p:�. y 4 ,! Penny Taylo' air ,
Attest as t Chairman
signature only.-
Approvaiv as fi/ and le.ality:
I.
-4 Iglii
Jeffrey A. la ;. ow
a
INSTR 5463890 OR 5443 PG 3543
RECORDED 10/27/2017 9:59 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC$10.00