Backup Documents 07/10/2018 Item #16D 4 160
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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 SLIPCee-06A1
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is alreamplete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the Countorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human / 07/10/18
Services
2. County Attorney Office County Attorney Office �0. ,VA �1$
3. BCC Office Board of County CZ)S
Commissioners \f\S / -7`1l`
4. Minutes and Records Clerk of Court's Office
r wU PI"
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 07/10/18 Agenda Item Number 16D4 1.._.-
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 791-138791-649030-33525.1
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? 34A„..�P D p(qlamt.?1 lot
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 07.10.18 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 fo 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
i6D4
INSTR 5585539 OR 5532 PG 1893
RECORDED 7/13/2018 9:58 AM PAGES 2
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
Prepared by:Wendy Klopf COLLIER COUNTY FLORIDA
Collier County Community&Human Services Division REC$18.50
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, associated with the $26,729.70 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 -
A3 10 , 2018, Agenda Item Number 1(.Gla H .
CRYSTAL K.KINZEL,
ATTEST: BOARD • CO '1 TY COM i • • /RS
•INTERIM CLERK OF CO IER 1•UN 1' D-•
.___ 400
By (--\
B1: A
, DEPUTY CLEF 4,ft. o Chairman's ANDY SOLIS, CHAIRMAN
Approval for form and legality. signature Only.
0,...,e�
Jenni A. Belpedio �S
Assistant County Attorney L � a`
16134
EXHIBIT A
Lots 30 & 33 Chalice Estates, A Subdivision, as recorded in Plat Book 40, Pages 49 and 50, of
the Public Records of Collier County, Florida.
Organization Impact Fee Amount
Folio# Name Legal Subdivision Name (OR/Pg)
Faustin Estate, Charlee Habitat for
25967800849 Fortilis Lot33 Estates Humanity 3531/3748 $13,149.98
Poul Estate, Charlee Habitat for
25967802902 Debra L Lot 30 Estates Humanity 3679/0746 $13,579.72
Total $26,729.70
0