Backup Documents 01/22/2019 Item #16D 6 4-119 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
L1 a5. TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 0 6
l 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. Susan Golden Community and Human Lam; 1/18/2019
Services
2. Jennifer Belpedio County Attorney Office 1 1A3 cj
3. BCC Office Board of County
Commissioners \r"\ /)'' VA\\
4. Minutes and Records Clerk of Court's Office
(9.4)101 . ;:3€p*,,
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 missin formation.
Name of Primary Staff Susan Golden/C S Phone Number 252-2336
Contact/ Department
Agenda Date Item was 1/22/2019 Agenda Item Number 16.D.6
Approved by the BCC
Type of Document Release of Lien-CWIF Number of Original 1
Attached Documents Attached
PO number or account 111.138759.649030
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? Silo,vtdvuo
7 Stamp OK
2. Does the document need to be sent to another agency for additional signatures6. If yes, 7 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 SG
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 SG
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 SG
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 1/22/2019 and all changes made during theas not
meeting have been incorporated in the attached document. The County Attorney's +. I or
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the _
BCC,all changes directed by the BCC have been made,and the document is ready fo e +;Kim
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
INSTR 5664102 OR 5592 PG 2714
RECORDED 1/25/2019 9:45 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
REC$10.00
Prepared by: Susan Golden
Collier County Community and Human Services i L ('�
3339 E.Tamiami Trail,Building H,#211 1 V {J
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 Lien
Agreement for Deferral of 100% of Collier County Impact Fees for Owner Occupied Affordable
Housing Dwelling Units (the "Impact Fee Lien") executed by Deibi & Lidya M. Rosas to Collier
County, recorded on 02/02/2007 in Official Records Book 4178, Page 0922 of the Public Records
of Collier County, Florida, in consideration of $17,020.25, receipt of which is hereby
acknowledged does satisfy, remise, release, quitclaim, exonerate and discharge the Impact Fee
Lien against the premises conveyed by said Impact Fee Lien and more particularly described as
follows:
LOT 202,TRAIL RIDGE,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 44,PAGES
71 THROUGH 77, INCLUSIVE, OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA.
The undersigned is authorized to and does hereby satisfy and 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.
This Release of Lien was approved by the Board of County Commissioners on
Cet\U)1/4S-\\ , 2019, Agenda Item Number ko1 .
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYTA.L K:K4NZEL, CLERK COLLIER COUNTY, FLORIDA
_ - (1)
11A (� , A 4- By:
s_ e
rst est`fs.t®ChiirmaisPuTY CLERK / W. L. McDaniel,Jr.,
sig-attire only. Chairman
Approved as to form and legality:
Jenn er A. Belpedio
Assistant County AttorneyV-S27‘
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