Backup Documents 09/26/2017 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1604
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#I 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 Coun Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human Irk 09/07/2017
Services
2. County Attorney Office County Attorney Office 11�
3. BCC Office Board of County
Commissioners V1 4-1S/
. / / 1L\\-\
4. Minutes and Records Clerk of Court's Office (NiC ct a, 1,
3.
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/ HS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 09.1..17 Agenda Item Number 14148
Approved by the BCC �p
Type of Document Release of Lien Number of Original
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 31+( s7,
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? SkP p. ) cric_.. 4.43
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
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 /. 1
BCC,all changes directed by the BCC have been made,and the document is ready for the 6
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
1604
R 44
RECORDED INSTR5453116 9/29/O2017 9:1135 AM2PA03
DWIGHT E. BROCK,5CLERKPG OF THEGES CIRCUIT COURT
COLLIER COUNTY FLORIDA
Prepared by: Wendy Klopf REC$10.00
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 Habitat for Humanity of Collier County, Inc. to Collier
County, having met the 15 year affordability housing obligation associated with the $137,494.40
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 -
ate , 2017, Agenda Item Number 1 1_004
P of
ATTESY: BOARD 0 '• Y COMMISSIONERS
DWIGHT E BROCK,CLERK OF COLD• ' it TY,FLORIDA
B SS
,. By:
i ,I rh,`RK PENNY T R, CHAI'
AQaS t •
Ap_`, i, . :;;:g gality:
At 114
Jennifer A. Belpe s itk C�j `�
Assistant County A erney �\�
1604
EXHIBIT A
Various lots as listed below for,Naples Manor Addition, As Recorded in Plat Book 3, Page 67 &
68 of the Public Records of Collier County, Florida.
BCC
Approval
date/Item
#or
County 15 year
Managers CO date affordability Legal Description Folio Lien Impact Fee
Approval end date (OR/Pg) Amount
Naples Manor Addition,
8/14/00 3/26/2001 3/26/2016 Block 5, Lot 7 62093040002 2717/2142 $7,586.34
Naples Manor Addition,
8/14/00 3/26/2001 3/26/2016 Block 5, Lot 8 62093080004 2717/2149 $7,586.34
Naples Manor Addition,
8/14/00 3/26/2001 3/26/2016 Block 5, Lot 10 62093160005 2717/2163 $7,586.34
Naples Manor Addition,
2/8/00 3/19/2001 3/19/2016 Block 5, Lot 15 62093360009 2640/1101 $7,140.34
01/07/99 Naples Manor Addition,
16A24 5/25/2000 5/25/2015 Block 11, Lot 12 62099880004 2502/813 $6,169.52
Naples Manor Addition,
12/20/00 12/4/2001 12/4/2016 Block 12, Lot 3 62100160008 2756/3300 $7,698.82
Naples Manor Addition,
12/15/00 12/6/2001 12/6/2016 Block 12, Lot 4 62100200007 2756/3306 $7,698.82
8/3/99 5/23/2000 5/23/2015 Naples Manor Addition, 62101960003 2578/2526 $7,140.34
16A5 Block 13, Lot 14
8/3/99 Naples Manor Addition,
16A5 5/23/2000 5/23/2015 Block 13, Lot 15 62101980009 2578/2533 $7,140.34
Naples Manor Addition,
12/20/00 8/3/2001 8/3/2016 Block 14, Lot 7 62103000000 2756/3318 $7,698.82
Naples Manor Addition,
12/07/00 8/3/2001 8/3/2016 Block 14, Lot 8 62103040002 2756/3324 $7,698.82
Naples Manor Addition,
15/15/00 8/3/2001 8/3/2016 Block 14, Lot 9 62103080004 2756/3330 $7,698.82
2/23/99 Naples Manor Addition,
16A15 5/25/2000 5/25/2015 Block 14, Lot 20 62103520001 2518/1417 $6,779.52
12/14/99 Naples Manor Addition,
16A5 9/27/2000 9/27/2015 Block 14, Lot 23 62103640004 2622/546 $7,140.34
12/14/99 Naples Manor Addition,
16A5 9/27/2000 9/27/2015 Block 14, Lot 24 62103680006 2622/553 $7,140.34
12/14/99 Naples Manor Addition,
16A5 9/27/2000 9/27/2015 Block 14, Lot 25 62103720005 2622/560 $7,140.34
02/18/97 Naples Manor Addition,
16A7 4/30/1999 4/30/2014 Block 14,Lot 27 62103800006 2284/2235 $6,169.52
12/14/99 Naples Manor Addition,
16A5 6/28/2000 6/28/2015 Block 15, Lot 3 62104200003 2622/567 $7,140.34
12/14/99 Naples Manor Addition,
16A5 6/28/2000 6/28/2015 Block 15, Lot 4 62104240005 2623/1514 $7,140.34
Total $137,494.40