Backup Documents 09/13-14/2011 Item #16E11ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E I I
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
(Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The
completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on
the item.)
ROUTING SLIP
Complete routing lines #1 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 #I through #4, complete the
checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1.
appropriate.
(Initial)
Applicable)
2.
September 13, 2011
Agenda Item Number
16E 11
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. 5yeN
Landowner Permission Form
Number of Original
1
5. Ian Mitchell, Executive Manager
Board of County Co&missioners
I Documents Attached
�'lcjlll
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 Sue Filson, need 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
Melissa Hennig
Phone Number
252 -2957
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
September 13, 2011
Agenda Item Number
16E 11
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Landowner Permission Form
Number of Original
1
Attached
I
I Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Fors/ BCC Forms/ Original Documents Routing Slip
WWS Original 9.03.04
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
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
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 required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
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!
I: Forms/ County Fors/ BCC Forms/ Original Documents Routing Slip
WWS Original 9.03.04
16E11
MEMORANDUM
Date: September 21, 2011
To: Melissa Hennig, Environmental Specialist
Facilities Management Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: A landowner permission form to apply for Fish and Wildlife
Conservation Commission antlerless deer permits to facilitate
the Pepper Ranch Preserve Hunt Program
Attached for your records is a certified copy of the document referenced above,
(Item #16E11) approved by the Board of County Commissioners September 13, 2011.
The original will be held in the Minutes and Records Department as part of the
Board's Official Record. .
If you have any questions please call me at 252 -8406.
Thank you.
Attachment
16E11
Applicant Infori
Permit Number:
Applicant:
Hunt Club:
Property Name:
Primary County:
Landowner Permission Form
2011/2012 Season Antlerless Deer Permit
nation
AD -3295
Melissa Hennig
Pepper Ranch Preserve
COLLIER
Landowner Information
Landowner:
Collier County Board of County Commissioners
Number of Acres:
2512.00
Contact Name:
Melissa Hennig
Address:
3335 Tamiami Trail East, Suite 101
NAPLES, FL 34112
Phone Number:
(239) 252 -2957
The information provided above pertaining to my property is correct. I verify that there are no
pending legal disputes regarding the boundary or ownership of the described property and that said
property is under my lawful ownership or control. I also hereby authorize the above named
applicant as my agent to apply for an Antlerless Deer Permit on the lands identified as my property
above.
I authorize this permission as [CHECK ONE] Annual / _X_Recurring Permission.
W. 0, Vle- ! l/J/
Landowner Signature Printed Name Date
Approved as to for ='n & lecal ;sg`icietl
�;E -�� - , item #
Assistant Cols - AWdoq
Date _
Date
Reed
ATTEST'
M,MWE. BROCK,
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