Backup Documents 10/28/2025 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 3
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. Michelle Rubbo Community and Human MR 10/23/2025
Services
2. County Attorney Office County Attorney Office
(tD 10 I z8 lZc--
3. BCC Office Board of County � )
Commissioners 1 L/ 111 J Z S
4. Minutes and Records Clerk of Court's Office `
/6
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,Comm and Human Phone Number 239-252-6030
Contact/ Department Services
Agenda Date Item was October 28, 2025 Agenda Item Number 16.D.3
Approved by the BCC
Type of Document Recommendation to approve and authorized Number of Original 2
Attached the Chairman to sign One(1)mortgage Documents Attached
satisfaction for the SHIP loan program....
PO number or account
number if document is 1053.138791.649030.33907.1
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? No
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 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 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 MR
should be provided to the County Attorney Office at the time the item is input into
CivicPlus. 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 10/28/2025 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County CU4) 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 N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the C� an option for
Chairman's signature. this line.
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
16 D 3
INSTR 6749418 OR 6523 PG 3478
RECORDED 11/5/2025 4:14 PM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
Prepared by: Michelle Rubbo 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
Agreement for Deferral of 100% of Collier County Impact Fees for Single-Family Affordable
Housing Dwelling executed by Habitat for Humanity of Collier County, Inc., to COLLIER
COUNTY,recorded on 8/8/2000 in Official Records Book 2707,Page 2275 of the Public Records
of Collier County,Florida,having met the 15-year affordability housing obligation associated with
the$4,736.34 of SHIP Impact Fee Waivers, of which is hereby acknowledged does satisfy,remise,
release, quitclaim, exonerate and discharge the Impact Fee Lien against the premises conveyed by
said lien and more particularly described as follows:
LOT 12 OF CARSON LAKES AS SHOWN ON THE PLAT THEREOF AS RECORDED IN PLAT
BOOK 34, PAGES 94 THROUGH 96, OF THE PUBLIC RECORDS OF COLLIR 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 ; P5, Agenda
Item Number 16.D. 3 .
ATTEST.: BOARD OF COUNTY COMMISSIONERS
CRYST ''I : KINZEEL, CLERK COLLIER COUNTY, FLORIDA
ram,.
I
By: --. 441t,a419.0 "
By.
DIUTY CLERK B RT L. SAUNDERS, CHAIRPERSON
Attest as IQ Okairfnan's
signatureonly
Approved for form and legality:
CCD
ourtney L. DaSilva I111
Assistant County Attorney
CAO
16D3
INSTR 6749413 OR 6523 PG 3472
RECORDED 11/5/2025 4:10 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
Agreement for Deferral of 100% of Collier County Impact Fees for Single-Family Affordable
Housing Dwelling executed by Habitat for Humanity of Collier County, Inc., to COLLIER
COUNTY, recorded on 7/1/2004 in Official Records Book 3598, Page 1204 and re-recorded on
6/21/2005 in official records Book 3826, Page 2860 in Official Records of the Public Records of
Collier County, Florida, having met the 15-year affordability housing obligation associated with
the $12,033.58 of SHIP Impact Fee Waivers, of which is hereby acknowledged does satisfy,
remise, release, quitclaim, exonerate and discharge the Impact Fee Lien against the premises
conveyed by said lien and more particularly described as follows:
LOT 13,BLOCK 2 NAPLES MANOR,UNIT 1 AS RECORDED IN PLAT BOOK 3,PAGE 57, OF
THE PUBLIC RECORDS OF COLLIR 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),d.,,0,Agenda
Item Number 16.D.
ATTEST: n BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. K1NZE,I)CLERK COLLIER COUNTY, FLORIDA
By: By:
DEPUTY CLERK BURT L. SAUNDERS, CHAIRPERSON
Attest as to.Chor,id.-,'.>
sigrFturn or.v
Approved for form and legality:
Courtney L. DaSilva
Assistant County Attorney 4l l�f iS
CAO