Backup Documents 11/09/2021 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP ,
1
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 Att rney 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 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. Karina Bardales Community and Human 11/5/2021
Services
2. Jennifer Belpedio County Attorney Office f l 19 I a
3. BCC Office Board of County
Commissioners =c1)A?
4. Minutes and Records Clerk of Court's Office
itit+0,4 VA**
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 Phone Number 239-252-2338
Contact/ Depattmtent Grants Support Specialist/CHS Division
Agenda Date Item was November 9th,2021 Agenda Item Number 16.D.1
Approved by the BCC
Type of Document CWIF/Release of Lien.Habitat for Number of Original 2
Attached Humanity 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)
1. Does the document require the chairman's original signature? S 0 K
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 KB
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 KB
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 KB
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 KB 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 KB N/A is not
BCC, all changes directed by the BCC have been made, and the document is ready for the -`U`) an option for
Chairman's signature. this line.
** Please e-mail a recorded copy to Karina.Bardales@colliercountyfl.gov **
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 1
INSTR 6162886 OR 6045 PG 1121
RECORDED 11/22/2021 1
Prepared by:LisaN.Carr CLERK OF THE CIRCUIT COURT10:48AM ANDPAGES COMPTROLLER
Collier County Community and Human Services COLLIER COUNTY FLORIDA
3339 E.Tamiami Trail,Building H,#211 REC$10.00
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 Units (the "Impact Fee Lien") executed by Habitat for Humanity to Collier
County,recorded on 04/28/2021 in Official Records Book 5936,Page 0564,of the Public Records
of Collier County, Florida, in consideration of $22,573.46, receipt of which 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:
NAPLES MANOR ANNEX BLK 4 LOT 4 OR 1071 PG 380, 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 AJO v-eta6r
?7L L , 2021,Agenda Item Number iG•2• / .
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL C,LRK COLLIE C TY, FLORIDA
By: By:
Aft t0 ChIfA1 ±� ., PUTY C RK P NNY TA OR, CHAI ERSON
signature only.
Approved as to form and legality:
%.ckrag-
Jennifer A. Belpedio 0
Assistant County Attorney (3, \
160 1
INSTR 6162887 OR 6045 PG 1122
RECORDED 11/22/2021 10:48AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Lisa N.Carr 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 Units (the "Impact Fee Lien") executed by Habitat for Humanity to Collier
County,recorded on 04/28/2021 in Official Records Book 5936,Page 0568,of the Public Records
of Collier County, Florida, in consideration of $22,573.46, receipt of which 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:
GOLDEN GATE EST UNIT 44 E 75FT OF W 180FT OF TR 40, 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 /C/Ov-eim 6 Piy�
QT�, , 2021, Agenda Item Number I C, / .
ATTEST: BOARD • COUNTY COMMISSIONERS
CRYSTAL K:KINZEL,-CLERK COLLIE r if TY, FLO'
B : B
Uiet
Y Y: 011A18
Attest as to Chaion,n ,E ERK PENNY TAYLOR, CHAIRPERSON
signature only.
Approved as to form and legality:
Jenni A. Belpedio 0„}� 'a,
Assistant County Attorney