Backup Documents 10/23/2012 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP ---C----
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 9 • •
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU' 1 D(zip
ROUTING SLIP
Complete routing lines#1 through#4 as appropriate for additional signatures,dates,and/or information needed.If the document is already complete ith
exception of the Chairman's signature,draw a line through routing lines#1 through#4,complete the checklist,and forward to Ian Mitchell(line#5
p
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Priscilla Doria Housing, Human & Veteran
pi) 1ôì11/?.
Services Department
2
3.
4. Ian Mitchell, Executive Manager Board of County Commissioners ` <N'2.,S111,
5. Minutes and Records Clerk of Courts Office t0(2S1t7— z:2Of1'
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval.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,including Ian Mitchell,needs to contact staff for additional or missing
information.All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Priscilla Doria Housing,Human and Phone Number 252-5312
Contact Veteran Services Please call or e-mail
for pick up
Agenda Date Item was October 23,2012 Agenda Item Number 16.D.3
Approved by the BCC
Type of Document One(1)Release of lien Number of Original 1
Attached Signature needed on all documents. Documents Attached
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. Original document has been signed/initialed for legal sufficiency. (All documents to be PD
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.This includes signature pages from ordinances,
resolutions,etc. signed by the County Attorney's Office and signature pages from
contracts,agreements,etc.that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's PD
Office and all other parties except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date of BCC approval of the PD
document or the final negotiated contract date whichever is applicable.
4. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's PD
signature and initials are required.
5. In most cases(some contracts are an exception),the original document and this routing slip PD
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6. The document was approved by the BCC 10/23/2012(enter date)and all changes PD N/A is not
made during the meeting have been incorporated in the attached document.The an option for
County Attorney's Office has reviewed the changes,if applicable. line 6.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05
1603
INSTR 4756352 OR 4849 PG 2203
RECORDED 10/26/2012 3:58 PM PAGES 1
Prepared by: DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
Collier County COLLIER COUNTY FLORIDA
Housing,Human&Veterans Services Dept REC$10.00
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 Agreement executed by Denise D. Lounsbury to Collier County, recorded on February 1,
2006 in Official Records Book 3975, Page 2243, of the Public Records of Collier County,
Florida, in consideration of $8,712.70, receipt 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:
Unit 404, Building 3, Botanical Place, a Condominium, according to the declaration of
condominium thereof, recorded in Official Records Book 3933, Page 2655, of the Public
Records of Collier County, Florida.
The undersigned is authorized to and does hereby release this Lien with respect to the above-
named property, and consents to this Lien being forever discharged of record with respect to said
property.
Dated thisdi day of 6C her, 2012.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHLE B,ROCK, Clerk COLLIER COUNTY, FLORIDA
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Attest ?to peputy Clerk FRED W. COYLE, CHAI ANA
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Approved as to form and
legal s ciency:
V
al
Jeff E. .ht
Assista ' ounty Attorney