Backup Documents 09/14/2021 Item #16D 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 Q 7
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 2eftta( '/7
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is al dy 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. Maria Aldana Community and Human ,71 9/9/2021
Services
2. Jennifer Belpedio County Attorney Office ► L3I a
3. BCC Office Board of County b hh�_ R
Commissioners ^iy�J�
4. Minutes and Records Clerk of Court's Office
WJ 6111 gat q:a
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 Karina Bardales/Maria Aldana,Grants Phone Number 239-252-2338
Contact/ Department Support Specialist/CHS Div
Agenda Date Item was September 14,2021 Agenda Item Number 16.D.7
Approved by the BCC
Type of Document CWIF/Release of Lien. Columbus; Number of Original 3
Attached Galvan; and Jarstad Documents Attached
PO number or account
number if document is 791-138791-649030-33686.1
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)
�fl1. Does the document require the chairman's original signature? J
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 MA
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 N/A
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 MA
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 MA
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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 of your deadlines!
8. The document was approved by the BCC on above date and all changes made during MA N/A is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the MA N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. ails e.
** Please e-mail a recorded copy to Karina Bardales/Maria Aldana**
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
1 60 7
INSTR 6130520 OR 6014 PG 2051
RECORDED 9/21/2021 9:26 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Maria Aldana 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 Lien
Agreement for Deferral of 100% of Collier County Impact Fees for Owner Occupied Affordable
Housing Dwelling (the "Impact Fee Lien") executed by David M. and April D. Columbus, to •
COLLIER COUNTY, recorded on 05/23/2006 in Official Records Book 4042, Page 1593 of the
Public Records of Collier County, Florida, in consideration of $15,329.68 ($12,263.74 plus
interest) 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 20, BRISTOL PINES,ACCORDING TO THE MAP OR PLAT THEREOF RECORDED IN PLAT
BOOK 43,PAGE 78, 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 9 fi 4 (202.(
Agenda Item Number I G.D,7 .
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAI,k K. KINLIDI., CLERK COLLIER CO TY, FLORIDA
By: ►._. By:
D Y PENNY TAYL , CHAIRPERSON
Attest as to Chaimani
signature only.
Approved for form and legality:
Jennifer A. Belpedio 4,\1•
Assistant County Attorney
e
1 60 7
INSTR 6130521 OR 6014 PG 2052
RECORDED 9/21/2021 9:26 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
Prepared by:Maria Aldana 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 Deferral of 100% of Collier County Impact Fees for Owner Occupied Affordable
Housing Dwelling (the "Impact Fee Lien") executed by Edgar M. Galvan and Jaqueline Ramirez
Mendoza, to COLLIER COUNTY, recorded on 09/11/2008 in Official Records Book 4392, Page
4052 of the Public Records of Collier County,Florida, in consideration of$15,553.08 ($12,442.46
plus interest)having met the term is hereby acknowledged does satisfy,remise,release, quitclaim,
exonerate and discharge the Impact Fee Lien against the premises conveyed by said Impact Fee
Lien and more particularly described as follows:
LOT 115, LIBERTY LANDING, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT
BOOK 47, PAGES 71 THROUGH 73, INCLUSIVE, OF THE PUBLIC RECORDS OF COLLIER
COUNTY, FLORIDA
The undersigned is authorized to and does hereby satisfy and release this Lien with respect to the
above-named property, and consents to this Lien being forever discharged of record with respect
to said property.
This Release of Lien was approved by the Board of County Commissioners on 9 j y- ( 202 f,
Agenda Item Number 16.D.
r]
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZtt,CLERK COLLIER COUNTY, FLORIDA
t. n 4
B �1 By:y Drix6T E E PENNY TAYL , CHAIRP RSON
Attest as td Glair-Dian$
tianature rey,
Approved for form and legality:
09?
Jenm er A. Be pedio r\, ?�
Assistant County Attorney
1 60 7
INSTR 6130522 OR 6014 PG 2053
RECORDED 9/21/2021 9:26 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Maria Aldana 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 Lien
Agreement for Deferral of 100% of Collier County Impact Fees for Owner Occupied Affordable
Housing Dwelling (the "Impact Fee Lien") executed by Caroline A. Jarstad, to COLLIER
COUNTY, recorded on 02/03/2006 in Official Records Book 3976, Page 2709 of the Public
Records of Collier County, Florida, in consideration of$8,947.84 ($7,158.27 plus interest)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:
UNIT 203, BUILDING 4, BOTANICAL PLACE, A CONDOMINIUM, ACCORDING TO
DECLARATION OF CONDOMINIUM THEREOF RECORDED IN OFFICIAL RECORDS BOOK
3933, PAGE 2655, 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 a roved by the Board of County Commissioners on 1 ji(-I2021,
AgendaItemNumber 1 .�, r] •
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K.-KIN`ZL, CLERK COLLIER COUNTY, FLORIDA
•
By: Y �'1,�,� By:
DEPUTY LE PENNY TA R, CHAI RSON
Attest as to Chairman 5
Approved for form and legality:
Jennifer A. Belpe ' Q• 4N
Assistant County Attorney