Backup Documents 07/08/2014 Item #16D 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 0 8
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 Offic no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP fee-6)C41 2(
Com lete routin lines#1 throu h#2 as appropriate for additional si atures dates and/or information needed. If the document is ea com lete with the
P routing g Sn Y
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Atto y Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Jennifer A. Belpedio, ACA County Attorney Office D Cve I q_
2. BCC Office Board of County IAA z
Commissioners V14/47 '112-1\iA
3. Minutes and Records Clerk of Court's Office
1�n `7�z1�Iy (( 2c m
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 Elly Soto Mc uen,HHVS Phone Number (239)252-26 4
Contact/ Department
Agenda Date Item was 7/8/2014 Agenda Item Number 16D8
Approved by the BCC
Type of Document Satisfaction and Release of Lien Number of Original 1 t7
Attached Documents Attached
PO number or account N/A
number if document is
to be recorded S cl ca cik cd, ��M l e
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? esm 17-
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A 1/
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 esm ✓
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 Ram tJ\q
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 esm
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 esm
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip em
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 NO
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 7/8/14 and all changes made during esm t .
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 _ �j
Chairman's signature. (N
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
1608
INSTR 5010178 OR 5060 PG 656
RECORDED 7/23/2014 8:37 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Prepared by: Elly Soto McKuen COLLIER COUNTY FLORIDA
Collier County REC$10.00
Housing, Human& Veteran Services
3339 E. Tamiami Trail, Building H, #211
Naples, FL 34112
THIS SPACE FOR RECORDING
SATISFACTION AND 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 Lien Agreement for Deferral
of 100% of Collier County Impact Fees executed by Gabriela Garcia to Collier County, recorded on
September 9, 2006 in Official Records Book 4114, Page 1240, of the Public Records of Collier County, Florida,
in consideration of$15,323.20 ($12,258.56 plus accrued interest) 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 as follows:
Lot 65, Bristol Pines, according to the map or plat thereof recorded in Plat Book 43, Page 78, of the
Public Records of Collier County, Florida.
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.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF COLLIER
DWIGHT E. BROCK, CLERK COUNTY, FLORIDA
Tom enm _, ai an
•- .( erk
Dated: 1)l �� �' 'E Approved as to form and legality:
Attest as to ChairL)
signature only.
Jennifer A. Belpedio
Assistance County Attorney �
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