Backup Documents 04/10/2012 Item #16D 4ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines #I through #4 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 throw #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1. Priscilla Dona
Housing, Human & Veteran
Services Department
PD
04 2012
2.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
PD
for pick u
3.
April 10, 2012
Agenda Item Number
16.D.4
4. Ian Mitchell, Executive Manager
Board of County Commissioners
5. Minutes and Records
Clerk of Courts Office
Number of Original
1
}
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell, needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Priscilla Doria Housing, Human and
Phone Number
252 -5312
Contact
Veteran Services
(Initial)
Please call or e-mail
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
PD
for pick u
Agenda Date Item was
April 10, 2012
Agenda Item Number
16.D.4
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
One (1) release of lien
Number of Original
1
Attached
Signature needed on all documents.
Documents Attached
INSTRUCTIONS & CHECKLIST
L Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2 24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
ap)ro riate.
(Initial)
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
PD
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
PD
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
PD
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
PD
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
PD
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC 04/10/2012 (enter date) and all changes
PD
N/A is not
made during the meeting have been incorporated in the attached document. The
an option for
County Attorne 's Office Ihas reviewed the changes, if applicable.
line 6.
L Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2 24.05
16n 44
INSTR 4693270 OR 4796 PG 2365
RECORDED 5/12/2012 7:54 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by: COLLIER COUNTY FLORIDA
Collier County REC $10.00
Housing, Human & Veterans Services Dept
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 Freeman and Freeman, Inc. to Collier County, recorded on February 29, 2008 in Official
Records Book 4334, Page 1288, of the Public Records of Collier County, Florida, in consideration of
$19,300.01, 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 18, Pine Grove Subdivision, according to the plat thereof, recorded in Plat Book 2, Page 103, of
the Public Records of Collier County, Florida (420 Carver Street, Immokalee, FL 34142).
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.
Dated this I day of 52012.
ATTEST:
DWLGHT�.E eBROCK, Clerk
By�
e uty erk
.n�tK# %�!► � it
Approved as to form and
legal iciency:
AKAVright
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: �7 - W.
FRED W. COYLE, CHAI N