Backup Documents 06/24/2014 Item #16A 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO (Q(aq
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 ce later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP A 9
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 6/24/14
4. BCC Office Board of County Yom..
Commissioners J `\f// (\zt\4.
5. Minutes and Records Clerk of Court's Office 3,D Alt
6(91-) 14 ti 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. Wright,Code Enforcement Phone Number 252-2487
Contact/ Department /
Agenda Date Item was 6/24/14 L/ Agenda Item Number 16-A-9
Approved by the BCC
Type of Document Release and Satisfaction—Forney Number of Original 1
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)
I. Does the document require the chairman's original signature? 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 fmal 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 6/24/14 and all changes made during the KN
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 KN
BCC, all changes directed by the BCC have been made,and the document is ready for e
Chairman's signature. Wet
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
16A9
INSTR 5001371 OR 5052 PG 3459
RECORDED 6/30/2014 8:35 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
This Instrument Prepared By: COLLIER COUNTY FLORIDA
Jeff Wright REC$10.00
Code Enforcement Department
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:
Neil Forney
Respondent
The lien was recorded on March 21, 2012, in Official Records Book 4776, Page 3204, in
the Official Records of Collier County, State of Florida. The lien secures the principal
sum of eleven thousand one hundred fifty-four dollars and eighty cents ($11,154.80),
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, LORIDA
-y B . .___
t±e t as to Chain t?9eputy Clerk Tom H-'ning, C :' an
o.
Approved as to form and legality
Kevin Noell
Assistant County Attorney