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Backup Documents 05/08/2012 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP +etf, AQ, TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE (O( I 3 ROUTING SLIP Complete routing lines#1 through#4 as appropriate for additional signatures,dates,and/or information needed.If the document is already complete w. th exception of the Chairman's signature,draw a line through routing lines#1 through#4,complete the checklist,and forward to Ian Mitchell(line#5). 1( Route to Addressee(s) Office Initials Date (List in routing order) 1. Priscilla Doria Housing, Human &Veteran PD 06/12/2012 Services Department 2. 3. 4. Ian Mitchell, Executive Manager Board of County Commissioners 6/21/ 5. Minutes and Records Clerk of Courts Office —"PAR ---F'Y\ 02k2-- 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 Please call or e-mail for pick up Agenda Date Item was Maya,2012 Agenda Item Number 16.D.4 Approved by the BCC Type of Document One(1)release of lien Number of Original 1 Attached Signature needed on all documents. Documents Attached 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. 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 05/05/2012(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 Attorney's Office has reviewed the changes,if applicable. line 6. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WINS Original 9.03.04,Revised 1.26.05,Revised 2.24.05 1604 Prepared by: Collier County 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 Crescencio Lopez to Collier County, recorded on August 8, 2000 in Official Records Book 2708, Page 0140, of the Public Records of Collier County, Florida, in consideration of $4,736.34, 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: Golden Gate Estates, Unit 18, E 75FT of W 150FT of TR 108, of the Public Records of Collier County, Florida (671 12th Ave NE,Naples,FL 34120). 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 8 day of I.44 1 , 2012. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGIT,t IR©p K, Clerk COLLIER COUNTY, FLORIDA ' --A--440- (A)•te. A By .,�*xtest ttt;, ... s putty Clerk FRED W. COYLE, CHA AN Q Mural• ,d'4 Approved as to form and legal su .`ency: -_1 • V r/ Jeff EWht Assist. • 'ounty Attorney