Backup Documents 04/28/2015 Item #16C1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP i
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE N` Q
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 complet
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.
2.
3. County Attorney Office County Attorney Office .3°5!? 412S115
4. BCC Office Board of County
Commissioners "c5/ c((3a'l5
5. Minutes and Records Clerk of Court's Office '�S
14' )1 1�
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 Pam Callis,U ilties Finance Phone Number 252-2359
Contact/ Department
Agenda Date Item was 4/28/2015 Agenda Item Number 16-C-1
Approved by the BCC
Type of Document Satisfaction of Notice of Claim of Lien Number of Original 1
Attached Documents Attached
PO number or account 408-210152-649030
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. (Initial) Applicable)
1. Does the document require the chairman's original signature? S41),�„'e O K LK
2. Does the document need to be sent to another agency for additional signatures? If yes, LK
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed LK
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's LK
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 LK
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 LK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip LK
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 04/28/15 (enter date)and all changes LK
made during the meeting have been incorporated in the attached document. The
County 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 th-
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
This instrument prepared by: 16 C 1
Jennifer A.Belpedio
Assistant County Attorney
Office of the County Attorney INSTR 5115935 OR 5146 PG 2159
3299 East Tamiami Trail,Suite 800 RECORDEDWIGHT ROCK,5/1/201R KM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Naples,Florida 34112 COLLIER COUNTY FLORIDA
(239)252-8400 REC$10.00
SATISFACTION OF NOTICE OF CLAIM OF LIEN
FOR SANITARY SEWER SYSTEM IMPACT FEES
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, AS THE GOVERNING BODY OF COLLIER COUNTY AND AS
EX-OFFICIO THE GOVERNING BOARD OF THE COLLIER COUNTY WATER-SEWER DISTRICT, was the
owner and holder of a certain Lien against:
WILLIAM C. NOWLIN
1018 Manatee Road, Apt E-105
Naples, FL 34114-3917
The Lien was recorded on the 10th day of February, 2005, in Official Record Book 3731, Page 3984, in
the Office of the Clerk of the Circuit Court of Collier County, State of Florida. The Lien secures the principal sum
of One Thousand Fifty Five Dollars and No Cents ($1,055.00),plus accrued interest and penalties, if any, and
imposes certain obligations against real property situated in Collier County, Florida, described as follows:
APARTMENT E-105, UNIT 1, GULF WINDS CONDOMINIUM, AS RECORDED IN OFFICIAL
RECORDS BOOK 508, PAGES 165 THROUGH 224 OF THE PUBLIC RECORDS OF COLLIER
COUNTY, FLORIDA.
FOLIO NUMBER: 48483320000
Collier County, a political subdivision of the State of Florida, and the Collier County Water-Sewer
District, a political subdivision of the State of Florida, hereby acknowledges receipt of payment in full Satisfaction
of the Lien and hereby cancels the Lien.
The Clerk of the Circuit Court is hereby directed to record this Satisfaction of Lien in the Official
Records of Collier County, Florida, to acknowledge that the Lien ceases to exist.
IN WITNESS WHEREOF, the Board of County Commissioners of Collier County, Florida, and as
Ex-Officio the Governing Board of the Collier County Water-Sewer District, acting through its Chairman, directs
execution and recording of this Satisfaction of Lien,by action of the Board this a$+hday QJM2_ , 2015.
t4; '
ATThST ' BOARD OF COUNTY COMMISSIONERS
DWIGHT E.'BROC;, CLERK COLLIER COUNTY, FLORIDA, AS-tHE ,
GOVERNING BODY OF COLLIER
COUNTY AND AS EX-OFFICIO THE
-, est as to Cha $ ty Clerk GOVERNING BOARD OF THE COLLIER
-,, nature only. COUNTY WATER-SEWER DISTI CT
Approved as to form and legality:
eW
Jennifer A. Belpedio (7j
TIM NANCE, CHAIRMAN
�
Assistant County Attorney ,s?•-T