Backup Documents 01/22/2013 Item #16A 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE 2)8'
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
6
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already comp e e th e
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.
2.
3. County Attorney Office County Attorney Office
4. BCC Office Board of County T /
Commissioners ( 1,
5. Minutes and Records Clerk of Court's Office
`)m f 128(a
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 Jen Baker/Code Enforcement Phone Number 252-2444
Contact/ Department
Agenda Date Item was January 22,2013 Agenda Item Number 16.A.6 V/
Approved by the BCC
Type of Document Release of Liens Number of Original 2
Attached Documents Attached
PO number or account 111-138911-649030
number if document is
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?
Does the document need to be sent to another agency for additional signatures? If yes,
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
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
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
document or the final negotiated contract date whichever is applicable. `�s
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required. ►�.,J
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time t e item is input into SIRE.
Some documents are time sensitive and require forwarding t allahassee within a certain
time frame or the BCC's actions are nullified. Be aware your deadlines! C_J
8. The document was approved by the BCC on 1/22/13 and all changes made during the
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if a. .livable. ��-
�r,
9. Initials of attorney verifying that the attached document is the version approved by t
BCC, all changes directed by the BCC have been made,and the document is read, or the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised . •.1 ;Revised 11/30/12
16 A6 f."
This Instrument Prepared By: INSTR 4791782 OR 4879 PG 2809
Jen Baker RECORDED 1/29/2013 9:37 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Code Enforcement Department COLLIER COUNTY FLORIDA
2800 North Horseshoe Drive REC$10.00
Naples, FL 34104
(239) 252-2440
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA is the owner and holder of a
certain lien against all real and personal property owned by:
Alexander Dominguez and Joanka Diaz Dominguez,
Respondents
The lien was recorded on November 8, 2010 in Official Records Book 4621, Page 2459,
in the Official Records of Collier County, State of Florida. The lien secures the principal
sum of forty seven thousand one hundred two dollars and eighty four cents, plus
accrued interest and penalties, if any, and imposes certain obligations against real
property situated in Collier County, Florida, which property is described as follows:
NAPLES PARK UNIT 3 BLK 28 LOT 8
669 99th Ave N Naples, FL
Collier County, a political subdivision of the State of Florida, by execution of this Release
and Satisfaction of Lien, acknowledges payment as approved by the Board of County
Commissioners as satisfaction of the lien and hereby cancels said lien.
The Clerk of the Circuit Court is hereby directed to record this Release and Satisfaction
of,Lien in the Official Records of Collier County, Florida, to acknowledge that the lien
ceases to exist.
r. "(Ir;
ATTEST BOA r OUNT COMMISSIONERS
DWIQHT E.'BROt K, Clerk COL IE- U TY, FLORIDA
By:
tClerk mreorgia A. Hiller, Esq.,
Attest as to Cha Chairwoman
{gnature d
Approved as to form and legal sufficiency
Jeff iF fight
Assi County Attorney
16 A6 0
INSTR 4791783 OR 4879 PG 2810
This Instrument Prepared By: RECORDED 1/29/2013 9:37 AM PAGES 1
Jen Baker DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Code Enforcement Department COLLIER COUNTY FLORIDA
REC$10.00
2800 North Horseshoe Drive
Naples, FL 34104
(239) 252-2440
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA is the owner and holder of a
certain lien against all real and personal property owned by:
Alexander and Joanka C. Diaz Dominguez,
Respondents
The lien was recorded on August 2, 2010 in Official Records Book 4591, Page 1753, in
the Official Records of Collier County, State of Florida. The lien secures the principal
sum of Thirteen Thousand eighty dollars and fifty seven cents, plus accrued interest and
penalties, if any, and imposes certain obligations against real property situated in Collier
County, Florida, which property is described as follows:
NAPLES PARK UNIT 3 BLK 28 LOT 8
669 99th Ave N Naples, FL
Collier County, a political subdivision of the State of Florida, by execution of this Release
and Satisfaction of Lien, acknowledges payment as approved by the Board of County
Commissioners as satisfaction of the lien and hereby cancels said lien.
The Clerk of the Circuit Court is hereby directed to record this Release and Satisfaction
of Lien in the Official Records of Collier County, Florida, to acknowledge that the lien
ceases to exist.
r"r,Vic; AL,
=;'
ATTEST ,_ BOARD OF COUNTY C*MMISSIONERS
DWIGHT E.;BROCK, Clerk COLLIER *U 'T , F •RIDA
0� dcgt.iteak
Attest as to choinapity Clerk G: ;' -'/ 7ler, Esq.,
0ianare )0 i Ch= '�• an
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Approved as to form and legal sufficiency
0 .- A
Jeff ' right
Assi. :nt County Attorney