Backup Documents 06/27/2017 Item #16D 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6
6(j TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 0 9
)LQ),...icij:cto"9( 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. Elizabeth Hernandez Community and Human
Services � 03h 7
2. Jennifer Belpedio County Attorney Office %-0(13 IV) 1�
3. BCC Office Board of County Eby ��
Commissioners /S
4. Minutes and Records Clerk of Court's Office
-�-� lay. J,_ : ss—ok
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 Elizabeth Hernandez/CHS Phone Number 252-2338
Contact/ Department
Agenda Date Item was 6/27/17 Agenda Item Number 16.D.9
Approved by the BCC
Type of Document Release of Lien Number of Original
Attached Documents Attached 1
PO number or account One Letter of Authorization to use Habitat
number if document is for Humanity Recording 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. (Initial) Applicable)
1. Does the document require the chairman's original signature? 5 v�e a k F 4- L) IA-
2. Does the document need to be sent to another agency for additional s : : • , • 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 EH
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 EH
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 EH
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 06/27/2017 and all changes made during the EH N/A is not
meeting have been incorporated in the attached document. The County Attorney's an option for
Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the E. N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the (' an option for
Chairman's signature. this line.
1: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
16D9
INSTR 5423482 OR 5410 PG 704
RECORDED 6/2812017 4:29 PM PAGES 1
OUNT/FLO 1 OF THE CIRCUIT COURT
Prepared by:Elizabeth Hernandez REC$10.00
Collier County COLL ER C
Community&Human Services Division
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 Immokalee Habitat for Humanity, Inc. to Collier County,
recorded on 01/16/1997 in Official Records Book 2272 Page 1777, of the Public Records of
Collier County, Florida, in consideration of$3,929.52 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, more particularly
described as follows:
LOT 2, 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.
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 -
Itmq 7 , 2017, Agenda Item Number �� �, 9 .
ATTEST:: BOARD 0 '0 Y COMMISSION S
DWIGHT El.BROC CLERK OF COL '' '•LINTY,FLORIDA
By.
t'St a& O, M. SLERK Penny Taylor, firman
sl at plam
ApproWO
val for foand legality:
Jennifer A. elpedio
Assistant County Attorney 0.5