Backup Documents 11/13/2012 Item #16F 1ORIGINAL DOCUMENTS CHECKLIST &
..t..r.ti.+wir..
6F
OUTING S `IP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
�r 21
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #I through #4 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 #4, complete the checklist,
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1
appropriate.
(Initial)
Applicable)
2.
November 13, 2011
Agenda Item Number
16F(1)
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
AP
4.
Release of Lien
Number of Original
1
s.
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
6. Minutes and Records
Clerk of Court's Office
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 need 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 nly after the BCC has acted to approve the item.)
Name of Primary Staff
Amy Patterson
Phone Number
252 -5721
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
November 13, 2011
Agenda Item Number
16F(1)
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
AP
Type of Document
Release of Lien
Number of Original
1
Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
INSTRUCTIONS & CHECKLIST
* Account for Recording 107 - 138920 - 649030.
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.: 43_
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
signed by the Chairman, with the exception of most letters, must be reviewed and signed
AP
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
NA
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
AP
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
AP
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
AP
should be provided to 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 on 11/13/2012 (enter date) and all
AP
changes made during the meeting have been incorporated in the attached document.
The Count Attorney's Office has reviewed the changes, if applicable.
— --
* Account for Recording 107 - 138920 - 649030.
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.: 43_
This instrument prepared by:
Amy Patterson
Collier County Growth Management Division
2800 North Horseshoe Drive
Naples, Florida 34104
(239) 252 -5721
16F 1
INSTR 4766136 OR 4857 PG 3103
RECORDED 11/26/2012 1:30 PM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC $10.00
RELEASE OF LIEN
KNOWN ALL MEN BY THESE PRESENTS: That Collier County, whose post office address
is 3299 East Tamiami Trail, Suite 303, Naples, Florida, 34112, the owner(s) and holder(s) of a
certain Impact Fee Agreement executed by St. Matthew's House, Inc. to Collier County,
recorded in Official Records Book 3054, Page 2986 of the Public Records of Collier County,
Florida, on June 12, 2002, hereby does remise, release, quitclaim, exonerate and discharge from
the lien and operation of said agreement, that certain portion of the premises conveyed by said
lien, more particularly described as follows:
Lots 1 through 8, inclusive, Block 67, Golden Gate, Unit 2, Part I, according to the plat
thereof, recorded in Plat Book 9, Pages 116 through 120, inclusive, of the Public Records of
Collier County, Florida. (4658 16th Place SW, Naples, Florida 34116).
The undersigned is authorized to and does hereby release this lien as to the whole of the above -
described real property and consents to this lien being discharged of record with respect to said
property.
Dated this `e7 day of (��jyenh6e� , 2012.
ATTEST: BOARD OF COUNTY COMMISSI
DWIGHT E. BROCK; CLERK COLLIER COUNTY, FLORIDA
By: By:
must As - ,1 le F D W. COYLE, CHAIRM)
'l1E$a
Approved form
and Aal s tiency
Jeffre}
County