Backup Documents 10/10/2017 Item #16D 4 dt ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 4
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 awak 10.10.17
Services
2. County Attorney Office County Attorney Office o c,' n
3. BCC Office Board of County —ML
Commissioners (rS/ kAkAk
4. Minutes and Records Clerk of Court's Office •
!a /0/11---11•Ifr4
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
10.10.17 Agenda Item Number 16D4
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:791-138791-649030-33467.1
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 Shia p p f` WK_
2. Does the document need to be sent to another agency for additt, . 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 10.10.17and all changes made during the WK
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 e g, �j
Chairman's signature. u"
L Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/ 110P /
16D4
INSTR 5457661 OR 5439 PG 1154
RECORDED 10/11/2017 3:47 PM 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 Habitat for Humanity of Collier County, Inc. to Collier
County, having met the 15 year affordability housing obligation associated with the $23,096.46
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 -
0c \a r t u , 2017, Agenda Item Number V.40.04+ .
ATTEST: ‘ BOARD 1Fit"TY COMMISSIONERS
DW . HT.E. BRO CLERK OF COL NTY,FLORID
I
B' ' as to c] mSCLERK By. PENNY T OR, CHAI
signature only.
Approval for f rm and legality:
Jennifer A. Belpedio
Assistant County Attorney qt, \‘
45
EXHIBIT A 1 b D 4
Various lots as listed below for, Naples Manor Unit 1, As Recorded in Plat Book 3, Page 57 of
the Public Records of Collier County, Florida.
County 15 year
Managers CO date affordability Legal Description Folio Lien Impact Fee
Approval end date (OR/Pg) Amount
Naples Manor Unit 1,
02/12/2001 02/26/2002 02/26/2017 Block 14, Lot 11 62047640005 2777/2075 $7,698.82
Naples Manor Unit 1,
02/12/2001 02/26/2002 02/26/2017 Block 14, Lot 8 62047520002 2777/2063 $7,698.82
Naples Manor Unit 1,
02/12/2001 03/26/2002 03/26/2017 Block 8, Lot 7 62044440004 2777/2051 $7,698.82
Total $23,096.46
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