Backup Documents 11/12/2019 Item #16D 7 7
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D
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. F.ettfretita
**NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the documentlrea�'y'�
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. Susan Golden Community and Human10/25/19
Services �i
2. Jennifer Belpedio County Attorney Office ---Sit II WI/
3. BCC Office Board of County hjriN +�
Commissioners �-t-k t C 1- P.Pi
4. Minutes and Records Clerk of Court's Office (\AA/
i1I (I 1i:2i-ljj
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 Susan Golden/CHS Phone Number 252-2336
Contact/ Department
Agenda Date Item was 11/12/2019 ,/ Agenda Item Number 16.D.7___
Approved by the BCC V _
Type of Document One SHIP IF ROL—Met term Number of Original 1 1/
Attached Documents Attached
PO number or account 791-138791-649030-33613.1
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. (I ' ' pplicable)
1. Does the document require the chairman's original signature? TAMP
OK
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 SG
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 SG
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 SG
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 item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware off our deadlines!
8. The document was approved by the BCC 11/12/2019 k'hd all changes made during the u.:.N'of
meeting have been incorporated in the attached document. The County Attorney's s i option for
Office has reviewed the changes,if applicable. ' is 'ne.
9. Initials of attorney verifying that the attached document is the version approved by the /A i. not
BCC,all changes directed by the BCC have been made,and the document is ready for the an o p ion for
Chairman's signature. • ine .
c ,\(-
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
160 7
INSTR 5790369 OR 5695 PG 903
RECORDED 11/14/2019 10:03 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Susan Golden REC$10.00
Collier County Community and Human Services
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 Agreement
for Deferral of 100% of Collier County Impact Fees for Single-Family Affordable Housing
Dwelling (the "Impact Fee Lien") executed by Habitat for Humanity of Collier County, Inc., to
COLLIER COUNTY, recorded on 10/09/2003 in Official Records Book 3418, Page 0920 of the
Public Records of Collier County, Florida, in consideration of$13,149.98 having met the term is
hereby acknowledged does satisfy, remise, release, quitclaim, exonerate and discharge the Impact
Fee Lien against the premises conveyed by said Impact Fee Lien and more particularly described
as follows:
LOT 11, CHARLEE ESTATES, as recorded in PLAT BOOK 40, Page 1, of the 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 11 1 A
2019, Agenda Item Number i(4,D'7
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTALe:: KINZEL, CLERK COLLIER CO r ORIDA
&?).
illii°:rr_ •
By: a . �AC By: /
.441
DEPU C t4 WILL AM L. MCDANIEL, JR, CHAIRMAN
Attest as f Chairman s
signature only. ° ' 1
Approved for form and legality:
Je er A. Belped -.-.-- cC}
, ' \O\
Assistant County Attorney e tiIA
\O\
0