Backup Documents 09/08/2015 Item #16A23 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP Q1-914-
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE c%
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County or y 0 ice
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney ffi o I r
than Monday preceding the Board meeting. ,,,rrr,,�+!!!�
**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.
2.
3. County Attorney Office County Attorney Office KN 9/8/15
4. BCC Office Board of County
Commissioners oAd`\c
5. Minutes and Records Clerk of Court's Office ( `< IC
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 Jeff E.Wight,Code Enforcement Phone Number 252-6077
Contact/ Department
Agenda Date Item was 9/8/15 Agenda Item Number 16-A-23
Approved by the BCC
Type of Document Release and Satisfaction—Delashment Number of Original Two
Attached Documents Attached
PO number or account
number if document is 111-138911-649030
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? STAMP OK KN
2. Does the document need to be sent to another agency for additional signatures? If yes, KN
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 KN
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 KN
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 KN
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 KN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KN
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 9/8/15 and all changes made during the KN N/A is not
meeting have been incorporated in the attached document. The County Attorney's an option for
Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the KN\c'c--k\ is not
BCC,all changes directed by the BCC have been made,and the document is ready for e � `` an tion for
Chairman's signature. �r `s 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
j. 3
6A2
1NSTR 51 iueeu uR 5 i93 PG 2204
RECORDED 9/10/2015 2.43 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
This Instrument Prepared By: REC$10 00
Jeff Wright
Code Enforcement Division
2800 North Horseshoe Drive
Naples, FL 34104
(239) 252-2440
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA is the owner and holder of a certain lien against all real and
personal property owned by:
Jerry Delashment Et Ux.
Respondent
The lien was recorded on August 14, 2013, in Official Records Book 4955, Page 492, in the
Official Records of Collier County, State of Florida. The lien secures the principal sum of two
thousand seven hundred twelve dollars and twenty-nine cents ($2,712.29), plus accrued interest
and penalties, if any, and imposes certain obligations against real property situated in Collier
County, Florida.
Collier County, a political subdivision of the State of Florida, by execution of this Release and
Satisfaction of Lien, acknowledges payment as approved by the Board of County
Commissioners as satisfaction of the lien and hereby cancels and releases said lien.
The Clerk of the Circuit Court is hereby directed to record this Release and Satisfaction of Lien
in the Official Records of Collier County, Florida, to acknowledge that the lien ceases to exist.
ATTEST BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA
y: By:
Deputy Clerk Tim Nance, Chairman
�e�#as to Chairman's /
Date: 0n faire u
onl , Date: q! 8Ji,_i
Approved as to form and legality
1--/, ‘77//71
Kevin Noell
Assistant County Attorney
CESD20130003907
16A23
INS T R 5170661 OR 5193 PG 2205
RECORDED 9/10/2015 2:43 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared By: COLLIER COUNTY FLORIDA
This Instrument Pre
p REC$10.00
Jeff Wright
Code Enforcement Division
2800 North Horseshoe Drive
Naples, FL 34104
(239) 252-2440
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA is the owner and holder of a certain lien against all real and
personal property owned by:
Jerry Delashment Et Ux.
Respondent
The lien was recorded on October 18, 2013, in Official Records Book 4976, Page 911, in the
Official Records of Collier County, State of Florida. The lien secures the principal sum of
twenty-nine thousand seven hundred twenty dollars and eighty-two cents ($29,720.82), plus
accrued interest and penalties, if any, and imposes certain obligations against real property
situated in Collier County, Florida.
Collier County, a political subdivision of the State of Florida, by execution of this Release and
Satisfaction of Lien, acknowledges payment as approved by the Board of County
Commissioners as satisfaction of the lien and hereby cancels and releases said lien.
The Clerk of the Circuit Court is hereby directed to record this Release and Satisfaction of Lien
in the Official Records of Collier County, Florida, to acknowledge that the lien ceases to exist.
ATTEST BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROC , Clerk COLLIER COUNTY, FLORIDA
e,aftede.„„.
Deputy Clerk Tim Nance, Chairman
a p� s�u, � tti �lairrr�an s
Date: ` Date: g/s46
Signature only.
Approved as to form and legality
Kevin Noell
Assistant County Attorney
CEPM20130003856