Backup Documents 05/13/2014 Item #16D10 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
i • a
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 co ete it
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. Mandy Moody HHVS M IY1 '", )(19 I■4
2.
3. Jennifer Belpedio County Attorney Office -4C)"'?) 5114/14,
4. BCC Office Board of County �S/ S\\�
Commissioners UL
5. Minutes and Records Clerk of Court's Office
- lefty
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/HHVS Phone Number 252-2338
Contact/ Department
Agenda Date Item was 05/13/2014 Agenda Item Number 16D.10
Approved by the BCC
Type of Document Release of Lien Number of Original I
Attached Documents Attached
PO number or account 1 check provided for recording,
number if document is return Mortgage Contracting Services
to be recorded Account
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? MM
2. Does the document need to be sent to another agency for additional signatures? If yes, DID"-
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. N
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 414.2tr- (J
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 - ` pi
should be provided to the County Attorney Office at the time the item is input into SIRE. I� '
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 05/14/13 and all changes made during MM ✓
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 the Gib
Chairman's signature. e
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
16010
INSTR 4983920 OR 5038 PG 2677
RECORDED 5/19/2014 8:22 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by:Mandy Moody COLLIER COUNTY FLORIDA
Collier County REC$10.00
Housing,Human&Veterans Services Dept
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 Impact
Fee Agreement executed by Alexi Campos and Maria A. Hernandez to Collier
County, recorded on 09/06/2001 in Official Records Book 2888, Page 1017, of the Public
Records of Collier County, Florida, in consideration of $3,636.62 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, more
particularly described in the aforementioned lien.
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 -
cL ( j , 2014,Agenda Item Number /6-b j o .
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK,'clerk COLLIER CO UNTY FLORIDA
4, By: i
Deputy Clerk
ern enning, Chal an
Attest as to,Cairman's
Approved as to form and
legality:
Jennifer A. Belpedio
Assistant County Attorney 4 \t(01' `�'