Backup Documents 03/12/2019 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP b )!
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO "-t
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 lecVrz i i
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document' ready 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. Jason Rummer Community and Human jnT 02.20.2019
Services
2. Jennifer Belpedio County Attorney Office , 3\r`p\
3. BCC Office Board of County ``', �
Commissioners \(s/ 3\ZTA\c
4. Minutes and Records Clerk of Court's Office p
rvw 3frfi
�' � f
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 Jason Rummer/ HS Phone Number 252-5505
Contact/ Department
Agenda Date Item was 03/12/2019 Agenda Item Number 16-D y ✓
Approved by the BCC
Type of Document 1 County-wide Impact Lien Release for Number of Original 1
Attached execution and recording. 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? o Jnr
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 Jur
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 Jnr
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 Jnr
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 on 03/12/2019 and all changes made • A is not
during the meeting have been incorporated in the attached document. The Countyoptioi f
Attorney's Office has reviewed the changes,if applicable. �� ®is an.
9. Initials of attorney verifying that the attached document is the version approved by the `i"i i /A IS-
BCC,
sBCC,all changes directed by the BCC have been made,and the document is ready for e �J a � e otto
Chairman's signature. this.inn
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 5693574 OR 5614 PG 3500
RECORDED 4/4/2019 9:37 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Jason Rummer REC$10.00
Collier County Community and Human Services
3339 E.Tamiami Trail,Building H,#211 6 0
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 Irette Augustin to Collier County,
recorded on 09/11//2008 in Official Records Book 4393, Page 0055 of the Public Records of
Collier County, Florida, in consideration of$15,553.08,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 104,LIBERTY LANDING,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 47,
PAGES 71 THROUGH 73, 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
ma ccln I a , 2019, Agenda Item Number I (p
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER COUNTY, FLORIDA
642 04,10
r` " 1_ By:
IJIPU 'L William L. McDani- ,Jr.
Attest asl4 Chairman's = Chairman
signature�0lli : u�•
'; 1 Approved as to form and legality:
I t
Je ' er A. Belpedio
Assistant County Atto -y p�