Backup Documents 11/12/2024 Item #16D 3 �c0� ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 46
�\� 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. Michelle Rubbo Community and Human MR 11/7/2024
Services
2. County Attorney Office County Attorney Office I /
3. BCC Office Board of County �J
Commissioners A(I 11 S
4. Minutes and Records Clerk of Court's Office 9'1 t
_I
D.q
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 Michelle Rubbo. Grants Support Specialist Phone Number 239-252-6030
Contact/ Depatttnent II,Community and Human Services
Agenda Date Item was November 12, 2024 Agenda Item Number 16.Do
Approved by the BCC
Type of Document Recommendation to approve and authorized Number of Original 1
Attached the Chairman to sign one(1)CWIF ROL Documents Attached
PO number or account
number if document is 1077.138711.649030.50137.1
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? MR
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 MR
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 MR
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 MR
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 MR
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 2/28/2023 and all changes made during S a s
the meeting have been incorporated in the attached document. The County pth
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the ccS fr :<< " , ;<<.t)(
Chairman's signature.
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
1603
INSTR 6613977 OR 6415 PG 2605
RECORDED 11/19/2024 1:31 PM PAGES 1
Prepared by:Michelle Rubbo CLERK OF THE CIRCUIT COURT AND 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(the"Impact Fee Lien")executed by Habitat for Humanity of Collier County,
Inc., to COLLIER COUNTY, recorded on 03/08/2024 in Official Records Book 6337, Page 550
of the Public Records of Collier County, Florida, in consideration of$12,676.32 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:
Kaicasa Phase One Lot 38
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 11112../2 y ,Agenda
Item Number 16.D.3 .
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER COUNTY, FLORIDA
1• Elton. _
By f P.J� , ' By:
r
" `Attest as do hai a�i'PTY CLERK CHRI ALL, CHAIRPERS N
'` ' signature only
Approved for form and legality:
Car nseverino
As ' tant County Attorney •