Backup Documents 06/13/2017 Item #16D 1 a ,
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 0 1
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 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. Wendy Klopf Community and Human 06/13/17
Services
2. County Attorney Office County Attorney Office
act 4, pall-)
3. BCC Office Board of County 6`\
Commissioners ‘04-161/
4. Minutes and Records Clerk of Court's Office —re /13/J1 3,'--Pm
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 Wendy Klopf/CHS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 06/13/17 Agenda Item Number tuts 1/-
Approved
/Approved by the BCC
Type of Document Release of Lien ✓ Number of Original 1
Attached Documents Attached
PO number or account Please use the SHIP account string for /
number if document is recording:
to be recorded 791-138791-649030-33467.1
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. .rr (Initial) Applicable)
1. Does the document require the chairman's original signature? 51-' WK
2. Does the document need to be sent to another agency for additional si atures? , NA
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 WK
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 NA
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 WK
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 WK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
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 06/13/17 and all changes made during WK
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 WK
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature. .,‘\
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
INSTR 5417861 OR 5405 PG 1712
RECORDED 6/14/2017 1:35 PM PAGES 2
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC $18.50
Prepared by:Wendy Klopf
Collier County Community&Human Services Division D
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 Waiver Agreements executed by Immokalee Habitat for Humanity, Inc. to Collier
County, having met the 15 year affordability housing obligation associated with the
$113,956.08* of SHIP Impact Fee Waivers, 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:
See Exhibit A
The undersigned is authorized to and does hereby release these Liens with respect to the above-
named properties, and consents to these Liens being forever discharged of record with respect to
said properties.
This Release of Lien was approved by the Board of County Commissioners on -
75u.n ( 3 ,2017, Agenda Item Number 110.ds I .
ATTEST: BOARD 1 .CO '4 TY COMMISSIO RS
DWIGHT E.BROCK, CLERK OF CO _' OUNTY,FLORID
By: CULL( • G . By:
,D. ' Y
Attest . . PENNY T OR,CHAI',y�'�.N
aha��• ��
Approvaii.;1.,, ypgality:
Jennifer A.Belpedio
Assistant County Attorney
1601
EXHIBIT A
LOT 1, LOTS 3 TO 8 AND LOTS 10 TO 31, BULLARD SUBDIVISION, ACCORDING TO
THE PLAT BOOK THEREOF, AS RECORDED IN PLAT BOOK 27, AT PAGES 76 AND 77,
OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA.
Lien
Legal Description (OR/Pg) Amount
Lot 1,Bullard Subdivision 2272/1771 $3,929.52
Lot 3,Bullard Subdivision 2272/1783 $3,929.52
Lot 4,Bullard Subdivision 2272/1789 $3,929.52
Lot 5,Bullard Subdivision 2272/1795 $3,929.52
Lot 6,Bullard Subdivision 2272/1801 $3,929.52
Lot 7,Bullard Subdivision 2272/1807 $3,929.52
Lot 8,Bullard Subdivision 2272/1813 $3,929.52
Lot 10,Bullard Subdivision 2272/1825 $3,929.52
Lot 11,Bullard Subdivision 2272/1831 $3,929.52
Lot 12,Bullard Subdivision 2272/1837 $3,929.52
Lot 13,Bullard Subdivision 2272/1843 $3,929.52
Lot 14,Bullard Subdivision 2272/1849 $3,929.52
Lot 15,Bullard Subdivision 2272/1855 $3,929.52
Lot 16,Bullard Subdivision 2272/1861 $3,929.52
Lot 17,Bullard Subdivision 2272/1867 $3,929.52
Lot 18,Bullard Subdivision 2272/1873 $3,929.52
Lot 19,Bullard Subdivision 2272/1879 $3,929.52
Lot 20,Bullard Subdivision 2457/2738 $3,929.52
Lot 21,Bullard Subdivision 2457/2745 $3,929.52
Lot 22,Bullard Subdivision 2457/2752 $3,929.52
Lot 23,Bullard Subdivision 2457/2759 $3,929.52
Lot 24,Bullard Subdivision 2457/2766 $3,929.52
Lot 25,Bullard Subdivision 2457/2773 $3,929.52
Lot 26,Bullard Subdivision 2457/2780 $3,929.52
Lot 27,Bullard Subdivision 2457/2787 $3,929.52
Lot 28,Bullard Subdivision 2457/2794 $3,929.52
Lot 29,Bullard Subdivision 2457/2801 $3,929.52
Lot 30,Bullard Subdivision 2457/2808 $3,929.52
Lot 31,Bullard Subdivision 2457/2815 $3,929.52
Total * $ 113,956.08