Backup Documents 09/10/2019 Item #16D10 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6010
d' i?lt) TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
HE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pinr. 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 ,In7 „ 09/06/2019
Services
2. Jennifer Belpedio County Attorney Office
3. BCC Office Board of County .3\Aby `
Commissioners —s(4/ c \ \l�
ta4. Minutes and Records Clerk of Court's Office G//,* 3.13 ,D'r
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/C S Phone Number 252-5505
Contact/ Department /
Agenda Date Item was 09/10/2019 Agenda Item Number ,Jj
Approved by the BCC / /6 ,, /0
Type of Document RELEASE OF IMPACT FEE LIEN ✓ 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? 5 0 K. NA
2. Does the document need to be sent to another agency for additional signature ? 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 INR
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 taware of your deadlines!
8. The document was approved by the B C /bndl t II'changes made during the meeting N/A is not
have been incorporated in the attached document. The County Attorney's Office has — an option for
reviewed the changes,if applicable. is line.
9. Initials of attorney verifying that the attached document is the version approved by th n ry t N A is not
BCC,all changes directed by the BCC have been made,and the document is ready fo the —410 -"' a option for
Chairman's signature. tis line.
p
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
16010
INSTR 5765188 OR 5673 PG 2016
RECORDED 9/13/2019 10:08 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
REC$10.00
Prepared by:Jason Rummer
Collier County Community and Human Services
3339 E.Tamiami Trail,Building H,ti2I
Naples,FL 34112
THIS SPACE FOR RECORDING
t
R>CL>GASE 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 fimr Owner Occupied Affordable
Housing Dwelling Unit (the "Impact Fee Lien") executed by Habitat of Humanity to Collier
County,recorded on 04/24/2019 in Official Records Book 5621,Page 2965 of the Public Records
of Collier County,Florida,in consideration of$$,015.82,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:
I'ARCIL ID/FOLIO NO. 00725080004, STREET NO. 1019, STREET— DOCKSIDE CT. NAPLES, FI. 34114
LEGAL DESCRIPTION—DOCKSIDE CT.BLDG.6,UNIT 606
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.
Se..tcr b to -zs::lc‘
This Release of Lien was approved by the Board of County Commissioners on ,
Agenda Item Number I (p 1 O.
A'I"I`EST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K.KINZEL,CLERK COLLIER COU►TY,FLORIDA
. •• .• , 42. Ce)
4 13 - ' C ;ter_ � ,.1
* Affost • t�� F�PLJ'1'Y CLERK Wil 'am L. McDaniel, Jr, CHAIRMAN
►.pnatuiety:. -
•
a P/;`
Approved as to form and legality:
-- t cam+ (�
Jennifer A.Belpcdi t
Assistant County Attorney �t \`�