Backup Documents 06/25/2019 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 0 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 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 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. JASON RUMMER Community and Human 06.18.2019
Services
2. Jennifer Belpedio County Attorney Office �, f� G 'aS\A
3. BCC Office Board of County -- ��
Commissioners \r (r (;)\2--(c)\'
4. Minutes and Records Clerk of Court's Office
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 missing information.
Name of Primary Staff JASON RUMMER CHS Phone Number 252-5505
Contact/ Department
Agenda Date Item was 06.25.2019 ✓ Agenda Item Number I/
Approved by the BCC b
Type of Document AHDB LIEN RELEASE ✓ Number of Original 1
Attached Documents Attached
PO number or account 111.138.759.649030
number if document is
to be recorded
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. Does the document require the chairman's original signature? 0 1,�' NA
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 JNR
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 NA
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 JNR
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 JNR
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the it m is input into SIRE.
Some documents are time sensitive and require forwarding to T ahassee within a certain
time frame or the BCC's actions are nullified. Be aware of r deadlines!
8. The document was approved by the BCC 06/25/2019 all changes made during the
meeting have been incorporated in the attached document. The County Attorney's s. • a
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the 11
BCC,all changes directed by the BCC have been made,and the document is ready for!.he pQ f
Chairman's signature. c
6(‘—'
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
INSTR 5734006 OR 5647 PG 3443 6 13 5
RECORDED 7/2/2019 8:16 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
, Prepared by:Jason Rummer COLLIER COUNTY FLORIDA
Collier County Community and Human Services REC$10 00
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 Lien
Agreement for Affordable Housing Density Bonus (the "AHDB Lien") executed by Gregory A.
Kee,a single man to Collier County,recorded on 10/25/2016 in Official Records Book 5326,Page
3017, of the Public Records of Collier County, Florida, in consideration of$13,750.17, receipt of
which is hereby acknowledged does satisfy, remise, release, quitclaim, exonerate and discharge
the Affordable Housing Density Bonus Agreement against the premises conveyed by said AHDB
Lien and more particularly described as follows:
LOT 187, BRISTOL PINES, PHASE II, ACCORDING TO THE PLAT THEREOF RECORDED IN
PLAT BOOK 46, PAGE 67, PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA.
The undersigned is authorized to and does hereby satisfy and 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 June 25, 2019,
Agenda Item Number k c,-A--)-S .
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, COLLIER P • ORIDA
CLERK .' = ( t) ftt-
r;,. .
By: By: `.O.
st as tv
h4. .� PUTY CLERK WIL'IAM L. MCDANIEL JR., CHAIRMAN
Atte .Isignature only.
Approved as to form and legality:
.i 1aNh
Jenni'A. Belpe'io 'N�
Assistant County At orney •\\