Backup Documents 09/22/2015 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO fl
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 e t C1 y� 124
Complete routing lines#1 through#2 as appropriate for additional signatures.dates,and/or information needed. If the document i already comp ete 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 Initial Date
1. Peggy Hager Community and Human /
Services /. /
3
2. County Attorney Office County Attorney Office
3. BCC Office Board of County
Commissioners �1 /\/ 4.4t\\S
4. Minutes and Records Clerk of Court's Office
rY �V 114i t VAS(A-
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 Mandy Moody,Grant Support Spe ialist, Phone Number
239-252-2338
Contact/ Department Community and Human Servi es
Agenda Date Item was Agenda Item Number
Approved by the BCC September 22,2015 16.D.4 t,
Type of Document Release of Liens Number of Original 4
Attached Documents Attached
PO number or account Recording Fee paid by check or memo
number if document is attached Account#
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. (In' ' Applicable)
1. Does the document require the chairman's original signature? M'-
Stamp
ok
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 MM
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 MM
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 MM
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 o _ and all changes made during MM-
the meeting have been incorporated in the attac ed document. The County No 1 % r
Attorney's Office has reviewed the changes,if a}plicable. ange `+
9. Initials of attorney verifying that the attached d•" ment is the version approved by the
BCC,all changes directed by the BCC have .-en made and the document is ready for th
Chairman's signature. ?/ � y 111 /
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
16fl4
Martha S. Vergara
From: Martha S. Vergara
Sent: Monday, October 05, 2015 10:55 AM
To: Moody, Mandy
Subject: Agenda Item #16D4 from the 9/22/15 BCC Meeting
Attachments: Mandy Moody.pdf
Attached for you.
Martha Vergara, BMR Senior Clerk
Minutes and Records Dept.
Clerk of the Circuit Court
& Value Adjustment Board
Office: (239) 252-7240
Fax: (239) 252-8408
E-mail: martha.vergara@collierclerk.com
„
It
INSTR 5176186 OR 5198 PG 839
RECORDED 9/28/2015 9:30 AM PAGES 1
Prepared by:Mandy Moody DWIGHT E. BROCK, CLERK OF THE CIRCUIT LOUR T
Collier County COLLIER COUNTY FLORIDA
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 and holder of a certain Impact Fee
Agreement executed by Habitat for Humanity of Collier County Inc., to Collier County,
recorded on 12/03/01 in Official Records Book 2935, Page 1168, of the Public Records of
Collier County, Florida, in consideration of$7,698.82, receipt of which is hereby acknowledged
does remise, release, quitclaim, exonerate and discharge from the lien and operation of the said
agreement, that certain portion of the premises conveyed by said lien, described in the
aforementioned Impact Fee Agreement.
The undersigned is authorized to and does hereby release this Lien with respect to the above-
named property, and consents to this Lien being forever discharged of record with respect to said
property.
This Release of Lien was approved by the Board of County Commissioners on -
Se p4e vv.%be►e-o?, , 2015, Agenda Item Number i(O 4 .
ATTEST: BOARD OF COUNTY COMMISSIONERS
•
DWIGHT E. BROCK Clerk COLLIER COUNTY, FLORIDA
.4,---tl, A. .,, : ,By.l '�, ,''' / e,//
Attest as to Chairman►'$
lit.y� IIM k Tim Nance, Chairman
signature only.
Approved as to form and
legality:
C::: P) .
Jennifer A. Belpedio
Assistant County Attorney �
q,\
Li
INSTR 5176187 OR 5198 PG 840
RECORDED 9/28/2015 9:3p AM PAGES 1
DWIGHT E. BROCK, CLERK OF t HE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by:Mandy Moody 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 and holder of a certain Impact Fee
Agreement executed by Jose Luis Lora to Collier County, recorded on 06/24/04 in Official
Records Book 3593, Page 2732, of the Public Records of Collier County, Florida, in
consideration of $14,589.05, receipt of which is hereby acknowledged does remise, release,
quitclaim, exonerate and discharge from the lien and operation of the said agreement, that certain
portion of the premises conveyed by said lien, described in the aforementioned Impact Fee
Agreement.
The undersigned is authorized to and does hereby 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 e-cv,n)0-e Y- 2 2, 2015, Agenda Item Number I Cp b + ..
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA
/ A& ey , y: eAre-e.—
Attests to Chairman's Dep{ut Cl-r e Tim Nance, Chairman
signature only.
Approved as to form and
legality:
Jennifer A. Belpedio �7 ,a.
Assistant County Attorney Cb'
may..
J
INSTR 5176188 OR 5198 PG 841
RECORDED 9/28/2015 9:30 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by:Mandy Moody COLLIER COUNTY FLORIDA
Collier County REC$10.00
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 and holder of a certain Impact Fee
Agreement executed by Roderick McDonald & Tania McDonald to Collier County, recorded
on 04/29/04 in Official Records Book 3551, Page 3903, of the Public Records of Collier County,
Florida, in consideration of $10,498.98, receipt of which is hereby acknowledged does remise,
release, quitclaim, exonerate and discharge from the lien and operation of the said agreement,
that certain portion of the premises conveyed by said lien, described in the aforementioned
Impact Fee Agreement.
The undersigned is authorized to and does hereby 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 -
Sc D reyn h>°v 2015,Agenda Item Number .
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA
►. l
By . _ By: 1 '� �..
Attest as to Chau ' ,N. D•pu *r'""erk Tim Nance, Chairman
ns:
signature,only: _
Approved as to form and
legality:
Jennifer A. Belpedio 46
Assistant County Attorney c�
INSTR 5176200 OR 5198 PG 895
RECORDED 9/28/2015 9:43 AM PAGES 1
Prepared by:Mandy Moody DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Collier County COLLIER COUNTY FLORIDA
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 and holder of a certain Impact Fee
Agreement executed by Immokalee Habitat for Humanity of Collier County Inc. to Collier
County, recorded on 11/07/97 in Official Records Book 2361, Page 0919, of the Public Records
of Collier County, Florida, in consideration of $6,169.52, receipt of which is hereby
acknowledged does remise, release, quitclaim, exonerate and discharge from the lien and
operation of the said agreement, that certain portion of the premises conveyed by said lien,
described in the aforementioned Impact Fee Agreement.
The undersigned is authorized to and does hereby 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 -
Sr 0 vvOrr,( 2D\ , 2015, Agenda Item Number lc, b a-
ATTEST:, ,:..,4',; BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK Clerk COLLIER COUNTY, FLORIDA
'It
BM �� v By: ! �i� �.
Y t
Attest as to Cha titian's D- •ut irk Tim Nance, Chairman
signature only.
Approved as to form and
legality:
Jennifer A. Belpedio \\5
Assistant County Attorney a-
9