Backup Documents 09/26/2017 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI D
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 2
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 09.07.17
Services
2. County Attorney Office County Attorney Office CA-A.1) 1 jak`3. BCC Office Board of County
Commissioners VS/ q\Z-6�-t
4. Minutes and Records Clerk of Court's Office
(k 17 )) r) 3:LOPkt
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/C S Phone Number 252-2901
Contact/ Department /
Agenda Date Item was 09.14.17 Agenda Item Number 47—
Approved by the BCC 31.0 �bD2,
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:791-138791-649030-33525.1
to be recorded 33''f 1.61 ,
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? SAaat 0'V c3AIK 3-INd
2. Does the document need to be sent to another agency for additional signatures? If yes, 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 09.12.17 and all changes made during WK o
the meeting have been incorporated in the attached document. The County }pt . `
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the ) i
BCC,all changes directed by the BCC have been made,and the document is ready for the •i
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
1602
INSTR 5453114 OR 5435 PG 2399
RECORDED 9/29/2017 9:11 AM PAGES 2
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by:Wendy Klopf REC$18.50
Collier County 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 Waiver Agreements executed by Immokalee Habitat for Humanity, Inc. to Collier
County, having met the 15 year affordability housing obligation associated with the $11,788.56
of SHIP Impact Fee Waivers, of which is hereby acknowledged does remise, release, quitclaim,
exonerate and discharge from the lien and operation of the said agreement, that certain portion of
the premises conveyed by said lien, more particularly described as follows:
See Exhibit A
The undersigned is authorized to and does hereby release these Liens with respect to the above-
named properties, and consents to these Liens being forever discharged of record with respect to
said properties.
This Release of Lien was approved by the Board of County Commissioners on -
CI��j4)` , 2017, Agenda Item Number Ilvi): .
4 = `'' BOARD 0/ l• Y COMMISSIONERS
D �$Q LEAK OF COL;." .: TY, FLORIDA
� r
By:AtteS<- . ., £ . By:
IJJ Ems{ PENNY TA R,CHAI• lii�'
e
A or9o and legality:
Jenni er A. Belpedio
Assistant County Attorney
16D2
EXHIBIT A
LOTS 1, 2 and 3, Gemmer Subdivision, As Recorded in Plat Book 24, Page 71 of the Public
Records of Collier County, Florida.
15 year Lien Impact Fee
BCC Approval CO date affordability Legal Description Folio (OR/Pg) Amount
date/Item# end date
04/18/1995 16A7 02/22/96 02/22/11 Lot 1 Gemmer Subdivision 34750000025 2061/1692 $ 3,929.52
04/18/1995 16A7 02/22/96 02/22/11 Lot 2 Gemmer Subdivision 34750000041 2061/1700 $ 3,929.52
04/18/1995 16A7 02/22/96 02/22/11 Lot 3 Gemmer Subdivision 34750000067 2061/1708 $ 3,929.52
Total $11,788.56