Backup Documents 06/28/2011 Item #16C4ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
-� 1-b
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE //1���
Print on pink paper. Attach to original document Original documents should be hand delivered bi the Board Office. The completed routing slip and �g�
documents are to be forwarded to the Board Office only after the Board has taken action on the item.) iiiiii
ROUTING SLIP
Complete routing lines k I through 94 as appropriate for additional signatures, dates, and/or information needed If the document is already completewith the
_rfl,> . ;—o ...P d,— a IPP, u,rnn..I. rondnv lints N1 thnuieh 94_ comnlete the checklist. and forward to Sue Filson (line45).
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1.
appropriate.
(initial)
Applic able)
2.
June 28, 2011
Agenda Item Number
1604
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
Number of Original
Type of Docurent
5. Executive Manager
Board of County Commissioners
Documents Attached
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who createcVprepared the executive
summary. Primary contact information is needed in the event one ol'the addressees above. inelnling Executive Manager, need to contact staff for additional or
missing information. All original documents needing the BCC Chairman's signature arc to be delivered to the BCC orrice only after the BCC has acted to approve
the it— i
Name of Primary Staff
Pam Callis
Phone Number
252 -2359
Contact
appropriate.
(initial)
Applic able)
Agenda Date Item was
June 28, 2011
Agenda Item Number
1604
A proved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Executive Summary, Exhibit A, and
Number of Original
Type of Docurent
Attached
Satisfactions of Notice of Promise To Pay
Documents Attached
INSTRUCTIONS & CHECKLIST
UTILITY BILLING AND CUSTOMER SERVICE DOES NOT REQUIRE COPIES OF
DOCUMENTS FILED WITH THE CLERK OF COURT — WE ONLY REQUIRE AN OFFICIAL
RECEIPT FROM THE CLERK.
I: Forms / County Forms/ BCC Forms / Original Documents Routing Slip W WS Original 9,03.04, Revised 1.26.05. Revised 224.05
X08- � /or5a- �y�o3o
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(initial)
Applic able)
1.
Original document has been signed /initialed for legal sufficiency. (All documents to be
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 os iibl State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
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
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
signature and initials are re wired.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to the Executive Manager in the BCC office within 24 hours of BCC
�cs
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 on 6 -28 -2011 enter date) 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.
UTILITY BILLING AND CUSTOMER SERVICE DOES NOT REQUIRE COPIES OF
DOCUMENTS FILED WITH THE CLERK OF COURT — WE ONLY REQUIRE AN OFFICIAL
RECEIPT FROM THE CLERK.
I: Forms / County Forms/ BCC Forms / Original Documents Routing Slip W WS Original 9,03.04, Revised 1.26.05. Revised 224.05
X08- � /or5a- �y�o3o
Prepared by:
Jennifer B. White
Assistant County Attorney
Office of County Attorney
3299 East Tamiami Trail, Suite 800
Naples, Florida 34112
(239) 252 -8400
1604
INSTR 4580961 OR 4697 PG 348
RECORDED 7/1/2011 8:49 AM PAGES I
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC $10.00
SATISFACTION OF NOTICE OF PROMISE TO PAY AND AGREEMENT TO EXTEND PAYMENT OF WATER
AND /OR SEWER SYSTEM IMPACT FEE
KNOW ALL MEN BY "THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS, COLLIER
COUNTY, FLORIDA, AS THE GOVERNING BODY OF COLLIER COUNTY AND AS EX- OFFICIO THE
GOVERNING BOARD OF THE COLLIER COUNTY WATER -SEWER DISTRICT, was the owner and holder of a certain
Agreement with the following:
JAN K. JACKSON, a single person
Whose mailing address is
134 7 "i STREET -FRAIL ACRES
NAPLES, FL 33962
Bearing the date of the 9 "' day of July 2001, recorded in Official Record Book 2855 Page(s) 2496, in the Office of
the Clerk of the Circuit Court of Collier County, State of Florida, which Agreement imposes a lien on the subject real
property. The Lien secures the principal sum of Three Thousand One Hundred Fifty Eight Dollars and Sixty Cents
($3,158.60) plus accrued interest and penalties, if any, and imposes certain obligations against real property situated in Collier
County, Florida, described as follows:
LOT 37, BLOCK 2, TRAIL ACRES, UNIT 2, ACCORDING TO PLAT THEREOF RECORDED IN PLAT
BOOK 4, PAGE 62, PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA, AS DESCRIBED IN THAT
DOCUMENT RECORDED IN OR BOOK 780, PAGE 434 OF THE PUBLIC RECORDS OF COLLIER
COUNTY, FLORIDA.
FOLIO NUMBER: 77262080008
Collier County, a political subdivision of the State of Florida, and the Collier County Water -Sewer District, a
political subdivision of the State of Florida, hereby acknowledges receipt of payment in full satisfaction of the Lien and
hereby cancels the Lien.
The Clerk of the Circuit Court is hereby directed to record this Satisfaction of Lien in the Official Records of Collier
County, Florida, to acknowledge that the Lien ceases to exist.
IN WITNESS WHEREOF, the Board of County Commissioners of Collier County, Florida, and • as'Ex - Officio the
Governing Board of the Collier County Water -Sewer District, acting through its Chairman, directs execution and recording
of this Satisfaction of Lien, by action of the Board this day of U—UNE , 2011.
ATTEST
DWI T E. BLOCK ILERK�y
L4w�_L_
Attest as togle�k
�i9rutwY �,l4
Approved as tto�fomi an legal sufficiency:
�� Tel
Jennifer`B. White
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS COLLIER
COUNTY, FLORIDA, AS THE GOVERNING BODY
OF COLLIER COUNTY AND AS- FX- OFFICIO THE
GOVERNING BOARD OF THE COLLIER COUNTY
WATER -SEWER DISTRICT
BY: _
FRED W. COYLE, CHAIRMAN)
Prepared by:
Jennifer B. White
Assistant County Attorney
Office of County Attorney
3299 East Tamiami Trail, Suite 800
Naples, Florida 34112
(239) 252 -8400
16C4
INSTR 4580962 OR 4697 PG 349
RECORDED 7/1/2011 8:49 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC $10.00
SATISFACTION OF NOTICE OF PROMISE TO PAY AND AGREEMENT TO EXTEND PAYMENT OF WATER
AND /OR SEWER SYSTEM IMPACT FEE
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS, COLLIER
COUNTY, FLORIDA, AS THE GOVERNING BODY OP COLLIER COUNTY AND AS EX- OFFICIO THE
GOVERNING BOARD OF THE COLLIER COUNTY WATER -SEWER DISTRICT, was the owner and holder of a certain
Agreement with the following:
MARIE WITHERS, A SINGLE PERSON
Whose mailing address is
P.O. BOX 1435
ROOKER BAY DRIVE, FL 34114
Bearing the date of the I '` day of March 2002, recorded in Official Record Book 2990 Page(s) 1179, in the Office of
the Clerk of the Circuit Court of Collier County, State of Florida, which Agreement imposes a lien on the subject real
property. The Lien secures the principal sum of Seven Hundred Twenty Nine Dollars and Eighteen Cents ($729.18) plus
accrued interest and penalties, if any, and imposes certain obligations against real property situated in Collier County, Florida,
described as follows:
LOT 139, PORT AU PRINCE, ACCORDING TO TI IE PLAT THEREOF, AS RECORDED IN PLAT
BOOK 13, PAGE 51, PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA.
FOLIO NUMBER: 68345400006
Collier County, a political subdivision of the State of Florida, and the Collier County Water -Sewer District,
a political subdivision of the State of Florida, hereby acknowledges receipt of payment in full satisfaction of the
Lien and hereby cancels the Lien.
The Clerk of the Circuit Court is hereby directed to record this Satisfaction of Lien in the Official Records of Collier
County, Florida, to acknowledge that the Lien ceases to exist.
IN WITNESS WHEREOF, the Board of County Commissioners of Collier County, Florida, and as Ex- Officio the
Governing Board of the Collier County Water -Sewer District, acting through its Chairman, directs execution and recording
of this Satisfaction of Lien, by action of the Board this th day of TUNE 2011.
ATTEST:
1 D HT E. BR K, CLERK
13 �p 1�
st �s Deputy Clerk
Ii it, qp��� 1
Approved'�ao toriand legal sufficiency:
Jennifer B'White
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS COLLIER
COUNTY, FLORIDA, AS THE GOVERNING BODY
OF COLLIER COUNTY AND AS EX-OFFICIOTHE
GOVERNING BOARD OF "FHE;COLLIER COUNTY
WATER -SEWER DISTRICT
BY: W,
FRED W. COYLE, CHAIRMA
Prepared by:
Jennifer B. White
Assistant County Attorney
Office of County Attorney
3299 East Tamiami Trail, Suite 800
Naples, Florida 34112
(239) 252 -8400
16C4
INSTR 4580963 OR 4697 PG 350
RECORDED 7/1/2011 8:49 AM PAGES 2
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC $18.50
SATISFACTION OF NOTICE OF PROMISE TO PAY AND AGREEMENT TO EXTEND PAYMENT OF
WATER AND /OR SEWER SYSTEM IMPACT FEE
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS,
COLLIER COUNTY, FLORIDA, AS THE GOVERNING BODY OF COLLIER COUNTY AND AS
EX- OFFICIO THE GOVERNING BOARD OF THE COLLIER COUNTY WATER -SEWER DISTRICT, was the
owner and holder of a certain Agreement with the following:
WILLIAM D. COLLINS 111, A SINGLE MAN
Whose mailing address is
951 Barefoot Williams Rd
Naples, FL 34113
Bearing the date of the 21" day of November 2003, recorded in Official Record Book 3448 Page(s) 2701,
in the Office of the Clerk of the Circuit Court of Collier County, State of Florida, which Agreement imposes a lien
on the subject real property. The Lien secures the principal sum of Two Thousand Six Hundred Forty Five Dollars
and No Cents ($2,645.00) plus accrued interest and penalties, if any, and imposes certain obligations against real
property situated in Collier County, Florida, described as follows:
THE NORTH HALF OF THE EAST HALF OF THE SOUTHEAST QUARTER OF THE NORTHEAST
QUARTER OF THE NORTHWEST QUARTER, LYING WEST OF BAREFOOT WILLIAMS ROAD,
AND THE NORTH HALF OF THE WEST HALF OF THE SOUTHWEST QUARTER OF THE
NORTHWEST QUARTER OF THE NORTHEAST QUARTER, LYING WEST OF BAREFOOT
WILLIAMS ROAD, SECTION 4, "TOWNSHIP 51, SOUTH, RANGE 26 EAST, COLLIER COUNTY,
FLORIDA AND SUBJECT TO A 30 FOOT RIGHT OF WAY FOR ROAD PURPOSES EXTENDING
ALONG THE NORTH BOUNDARY LESS THE SOUTH 75 FEET OF THE NORTH HALF OF THE
EAST HALF OF THE SOUTFEAST QUARTER OF THE, NORTHEAST QUARTER OF THE
NORTHWEST QUARTER LYING WEST OF BAREFOOT WILLIAMS ROAD AND THE SOUTH 75
FEET OF THE NORTH HALF OF THE WEST HALF OF THE SOUTHWEST QUARTER OF THE
NORTHWEST QUARTER OF THE NORTHEAST QUARTER LYING WEST OF BAREFOOT
WILLIAMS ROAD, SECTION 4, TOWNSHIP 51 SOUTH, RANGE 26 EAST, COLLIER COUNTY,
FLORIDA.
"THIS PROPERTY IS THE SAME PREMISES DESCRIBED IN THE DEED DATED 2/24/95
RECORDED IN O.R. BOOK 2034, PAGE 1462, AS AMMENDED TO CORRECT THE LEGAL
Pagc 1 of 2
16C4
DESCRIPTION BY THE CORRECTIVE DEED DATED 3/3/97, RECORDED IN O.R. BOOK 2312,
PAGE 172 OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA.
FOLIO NUMBER: 00728160002
Collier County, a political subdivision of the State of Florida, and the Collier County Water -Sewer
District, a political subdivision of the State of Florida, hereby acknowledges receipt of payment in full
satisfaction of the Lien and hereby cancels the Lien.
The Clerk of the Circuit Court is hereby directed to record this Satisfaction of Lien in the Official Records
of Collier County, Florida, to acknowledge that the Lien ceases to exist.
IN WITNESS WHEREOF, the Board of County Commissioners of Collier County, Florida, and as
Ex- Officio the Governing Board of the Collier County Water -Sewer District, acting through its Chairman, directs
execution and recording of this Satisfaction of Lien, by action of the Board this aft% day of
TUNE_ 2011.
ATTEST:
DWIGHT E. BLOCK, CLERK
t st s>, : i' i40giw
of gniftur� . oai �
Approved as to fffm`and legal
sufficiency:
� -�� V,�
Jennifer B. White
Assistant County Attorney
BOARD OF COUNTY COMMNSIONERS
COLLIER COUNTY, FLORIDA, AS THE
GOVERNING BODY OF COLLIER
COUNTY AND AS EX- OFFICIO THE
GOVERNING BOARD OF THE COLLIER
COUNTY WATER -SEWER DISTRICT
BY: _ W
FRED W. COYLE, CHAIR
Page 2 A'2