Backup Documents 01/22/2019 Item #16D 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6
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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 .).,h___ 1/18/19
Services
2. Jennifer Belpedio County Attorney Office (3 II a3 `19
.cit43
3. BCC Office Board of County .L\-\\t",
Commissioners \A\// / k\2k\\ct
4. Minutes and Records Clerk of Court's Office 144 I n 3;30
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 Susan Golden-C S Phone Number 252-2336
Contact/Department
Agenda Date Item was 01/22/2019 Agenda Item Number 16.D.T 1.6 t,t1...
Approved by the BCC
Type of Document Release of Lien—SHIP IF Number of Original
Attached Documents Attached 1
PO number or account 123-155974-649030-32001.1
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) Appli able
1. Does the document require the chairman's original signature? T, �.,�yV�
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 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. SG
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 01/22/19 and all changes made during the
meeting have been incorporated in the attached document. The County Attorney'sg,for
Office has reviewed the changes,if applicable. .-- -
9. Initials of attorney verifying that the attached document is the version approved by the :
6... 1. 31*Z:V1-9*;::--iii*,BCC,allchanges directed by the BCC have been made,and the document is ready for th :
Chairman's signature. / y
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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 5664069 OR 5592 PG 2668
RECORDED 1/25/2019 9:40 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Susan Golden REC$10.00
Collier County Community and Human Services
3339 E.Tamiami Trail,Building H,#211
Naples,FL 34112 1 6 0 7
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 Agreement
for Deferral of 100% of Collier County Impact Fees For Single-Family Affordable Housing
Dwelling (the "Impact Fee Lien") executed by Habitat for Humanity of Collier County, Inc. to
Collier County,recorded on 11/04/2003 in Official Records Book 3436, Page 3303, of the Public
Records of Collier County, Florida, in consideration of $13,149.98, 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 25, CHARLEE ESTATES,AS RECORDED IN PLAT BOOK 40,PAGE 1, 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 Comm'ss'oners on
mk( c- 1 , 2019, Agenda Item Number F
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL COLLIER C121;
, ORIDA
091/4dourm
CLE' (I)
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: I By: —
„ ;,,DEPUTY CLERK f W. L. McDaniel,Jr.,
to
alrrilafl's Chairman
signature mitt'
Approved as to form and legality:
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AD
Jennifer A. Belpedio ` 0 421* '�
Assistant County Attorney (Z \\
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