Backup Documents 06/11/2019 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
Co la. TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 D 4
1 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. JASON RUMMER Community and Human ix& 06.05.2019
Services
2. Jennifer Belpedio County Attorney Office n I.� j I C1
3. BCC Office Board of County
Commissioners \ � \kck
4. Minutes and Records Clerk of Court's Office 114/0 ti '' I 0( `3$
PPW
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 CHS Phone Number 252-5505
Contact/ Department
Agenda Date Item was 06.11.2019 Agenda Item Number / • a - i_f V
Approved by the BCC !
Type of Document AHDB LIEN HALM Number of Original 1
Attached Documents Attached
PO number or account 111.138.759.649030
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? NA
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 JNR
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 06/11/2019 and all changes made during the N/A is n
meeting have been incorporated in the attached document. The County Attorney's an option
Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the /A`'is not
BCC,all changes directed by the BCC have been made,and the document is ready for th (}"' option
Chairman's signature. 's line;
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 5726857 OR 5641 PG 2752 1 6 4
RECORDED 6/14/2019 10:07 AM PAGES 1
Prepared by:Jason Rummer CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Collier County Community and Human Services 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 Lien
executed by Patrick Halm, a married man to Collier County, recorded on 11/15/2016 in Official
Records Book 5333, Page 3430, of the Public Records of Collier County, Florida, in consideration
of $15,098.41, receipt of which is hereby acknowledged does satisfy, remise, release, quitclaim,
exonerate and discharge the Lien against the premises conveyed by said Lien and more particularly
described as follows:
LOT 194, BRISTOL PINES,PHASE II,ACCORDING TO THE PLAT THEREOF RECORDED IN PLAT BOOK
46, PAGE 67,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 s I I ,
2019, Agenda Item Number / , V, 1/,
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER COUNTY, FLORIDA
kV- By: 406641 - 041111A
Attest altaCLERK LIAR L. MCDANIEL, JR., C AIRMAN
c'. oto only.
Approved as to form and legality:
Jenn'r A. Belpedio
Assistant County Attorne' v' \\