Backup Documents 06/11/2013 Item #16D 2ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 160 2
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 Attorne Office no later
than Monday preceding the Board meeting.
*�N>�W'�*' RQUTIi;�tG SLAP �i9rLt1 !o / ?
Complete routing lines #1 through #2 as appropriate for additional signatures, dates, and/or information needed. If the document is alry complete with the
exception of the Chairman's signature, draw a line through routing lines #I through #2. complete the checklist_ and forward to the County Attorney Office_
Route to Addressees (List in routing order)
Office
Initials
Date
1. Wendy Klopf
HHVS
(Initial)
06/11/13
2. Jeffrey Wright
County Attorney Office
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3. BCC Office
Board of County
Commissioners
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3
4. Minutes and Records
-
Clerk of Court's Office
-
1
(2.415Pfn
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 missine information.
Name of Primary Staff
Wendy Klopf/HHVS
Phone Number
252 -2901
Contact / De artment
4ppropriate.
(Initial)
Applicable)
Agenda Date Item was
06/11/13
Agenda Item Number
16.D.2
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
NA
Type of Document
Release of Lim
Number of Original
1
Attached
Original document has been signed/initialed for legal sufficiency. (All documents to be
Documents Attached
PO number or account
"' 1 Habitat /Morvan release
numb is
Please use Habitat's account at the Chxls'
to b rec
fat the S10 Recording in per Norma Lara
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Habitat
INSTRUCTIONS & CHECKLIST
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
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Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
4ppropriate.
(Initial)
Applicable)
I.
Does the document require the chairman's original signature?
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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
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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
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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
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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
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signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
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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 Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware your deadlines!
8.
The document was approved by the BCC on 06/11/1 and all changes made during
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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 fo e
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Chairman's signature.
W ` lit
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
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INSTR 4854842 OR 4934 PG 1326
RECORDED 6/18/2013 2:40 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC $10.00
Prepared by: - -
Collier County
Housing, Human & Veterans Services Dept 16
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 November 21, 2002 in Official Records Book 3158 , Page 2377, of the Public
Records of Collier County, Florida, in consideration of $11,612.98 , 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 26, Block C, Habitat Village, according to the plat thereof as recorded in Plat Book 37, pages 48 through 51,
inclusive, 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 -
2013, Agenda Item Number
ATTES
DWfCv E.BRQ " "Clerk
Ai e
Attest R0 � a
signatu�o��• � �'��
Approved as to form and
legal fficiency:
Y
Je E Wright
A i ant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLL COUNTY, FLORIDA
By:
Ge rgia A. Hiller, Esq., Chairwoman
C7