Backup Documents 05/08/2018 Item #16D10 �� ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 p 10
�� 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 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. Lisa N. Can Community and Human in7t 5/11/18
Services
2. Jennifer Belpedio County Attorney Office I
ts («
3. BCC Office Board of County
Commissioners j°95 I 61
4. Minutes and Records Clerk of Court's Office ( 0RQ
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 Lisa N. Carr/CHS Phone Number 252-2339
Contact/Department
Agenda Date Item was 05/8/18 Agenda Item Number 16.D.10 17-
Approved by the BCC f
Type of Document Release of Lieu Number of Original
Attached Documents Attached 2 !�
PO number or account See attached information
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column - - Yes N/A(Not
appropriate. (Initial) A callle)
1. Does the document require the chairman's original signature? Slocxvim d K .,1
2. Does the document need to be sent to another agency for addi 'oval signatures'? If , NA
provide the Contact Information(Name;Agency;Address; Pho • • .• - e• sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be LNC
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 LNC
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 LNC
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 05/8/18 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 \1
BCC,all changes directed by the BCC have been made,and the document is ready for the VIZ
Chairman's si•nature.
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 5556821 OR 5510 PG 781
RECORDED 5/16/2018 11:14 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC$10.00
Prepared by:Lis N.Can
Collier County
Community&Human Service Division 16 D 10
3339 Tamiami Trail East#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 to Collier County,
recorded on August 16, 2002 in Official Records Book 3092, Page 0284, of the Public Records
of Collier County, Florida, in consideration of$4,622.98, upon satisfactory completion of the
terms and conditions of the Impact Fee which is hereby acknowledged does remise, release,
quitclaim, exonerate and discharge from the lien and operation of the said agreement, that certain
portion of the premises conveyed by said lien, more particularly described as follows:
Lot 1, Timber Ridge, Unit One, being a Subdivision of Tracts 5 and 6, Eden Park First
Addition, Recorded in Plat Book 5, Page 3, of the Public Records of Collier County,
Florida, being Part of Section 32, Township 46 South, Range 29 East.
The undersigned is authorized to and does hereby release this Lien with respect to the above-
named property, and consents to this Lien being forever discharged of record with respect to said
property.
This Release of Lien was approved by the Board of County Commissioners on � , 2018,
Agenda Item Number f L T .
ATTEST: BOARD OF , r TY COMM ,_ ONERS
DWIGHT E. BROCK, Clerk COLLIER OP• , FLO' ,
EO/wacjt
By:
,gest as tohaian'$Deputy Clerk Andy Solis, Chairman
signature only.
Approval for form and legality:
Jenn'£''r A. Belpedio
Assistant County Attorne p<N%
0
INSTR R
RECORDED5556822 5/16/O2018 11145510PG AM782 PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC$10.00
Prepared by:Lis N.Carr
Collier County
Community&Human Service Division D 0
3339 Tamiami Trail East#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 to Collier County,
recorded on March 7, 2002 in Official Records Book 2994, Page 3041, of the Public Records of
Collier County, Florida, in consideration of $10,428.82, upon satisfactory completion of the
terms and conditions of the Impact Fee 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 1, Block C, Habitat Village, according to the Plat thereof as recorded in Plat Book 37,
Pages 48 through 51, 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 wla D , 2018,
Agenda Item Number i I b
ATTEST: BOARD OF '• .TY COM ' ,IONERS
DWIGHT E. BROCK,Clerk COLLIE' 0 Y, FLO' P /.
- �
By:
;test as t C irm�e5puty Clerk Andy Solis, Chairman
Approval for form and legality:
Jenni er A. Belpedio p�
Assistant County Attorney PC\
cr