Backup Documents 05/25/2021 Item #16A 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP ! A 8
.50)>::, rt.)
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
a 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 routin&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.
2. Risk-Management Rill
3. County Attorney Office County Attorney Office CAK 5-25-21
4. BCC Office Board of County PT by JH/s/ 5-25-21
Commissioners
5. Minutes and Records Clerk of Court's Office * rC Z 1p'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 Illiana Burgos/Code Enforcement Phone 239-252-6865
Contact/ Department
Agenda Date Item was May 25,2021 Agenda Item Number 16A8
Approved by the BCC
Type of Document Code enforcement liens with an accrued value of Number of Original 2
Attached $95,397.40 for payment of$4,000 in the code Documents Attached
enforcement actions titled Board of County
Commissioners v.Deri Clark
PO number or account yes
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?STAMP OK N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 IB
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 N/A
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 IB
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 IB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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 May 25,2021 and all changes made IB 14/A is
during the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. s 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 the ' 'i op,' for
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
16A8
INSTR 6068259 OR 5955 P:726R 38This Instrument Prepared By: RECORDED 5/27/2021 4:46PAGES1Colleen A. Kerins, EsquireCLERKOFTHECIRCUITCT AND COMPTROLLER
Collier CountyAttorne 's Office COLLIER COUNTY FLORIDA
Y REC$10.00
3299 E. Tamiami Trail-Suite 800
Naples, FL 34112
(239) 252-8400
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA is the owner and holder of a certain lien against all real and
personal property owned by:
DERI CLARK,
Respondent
The lien was recorded on January 29, 2019, in Official Records Book 5593, Page 3651, in the
Official Records of Collier County, State of Florida. The lien secures the principal sum of one
thousand eight hundred twenty-three dollars and sixty-five cents ($1,823.65), plus accrued
interest and penalties, if any, and imposes certain obligations against real property situated in
Collier County, Florida.
Collier County, a political subdivision of the State of Florida, by execution of this Release and
Satisfaction of Lien, acknowledges payment as approved by the Board of County Commissioners
as satisfaction of the lien and hereby cancels and releases said lien.
The Clerk of the Circuit Court is hereby directed to record this Release and Satisfaction of Lien in
the Official Records of Collier County, Florida, to acknowledge that the lien ceases to exist.
ATTEST . �� BOARD F COUNTY COMMISSIONERS
CRYST • , Clerk COLLI NTY, FLORID
•Y ' By:
r .S `'� Penny Ta r, Chairper on
*• a�;:C only.
Date: G ' Date: 5"d5191
Approved as to form and leg • y
Colleen A. Kerins
Assistant County Attorney
[21-CE0-01551/1623680/1]
16A8
ThisINSTR 6068260 OR 5955 PG 2639
Instrument Prepared By:
RECORDED 5/27/2021 4 46 PM PAGES 1
Colleen A. Kerins, Esquire CLERK OF THE CIRCUIT COURT AND COMPTROLLER
Collier County Attorney's Office COLLIER COUNTY FLORIDA
3299 E. Tamiami Trail-Suite 800 REC$10.00
Naples, FL 34112
(239) 252-8400
RELEASE AND SATISFACTION OF LIEN
KNOW ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA is the owner and holder of a certain lien against all real and
personal property owned by:
DERI CLARK,
Respondent
The lien was recorded on January 29, 2019, in Official Records Book 5593, Page 3648, in the
Official Records of Collier County, State of Florida. The lien secures the principal sum of two
thousand five hundred seventy-three dollars and seventy-five cents ($2,573.75), plus accrued
interest and penalties, if any, and imposes certain obligations against real property situated in
Collier County, Florida.
Collier County, a political subdivision of the State of Florida, by execution of this Release and
Satisfaction of Lien, acknowledges payment as approved by the Board of County Commissioners
as satisfaction of the lien and hereby cancels and releases said lien.
The Clerk of the Circuit Court is hereby directed to record this Release and Satisfaction of Lien in
the Official Records of Collier County, Florida, to acknowledge that the lien ceases to exist.
ATTEST BOARD O COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, Clerk COLLIE'' Ce II TY, FLORID
By: /
Ali as BM Clerk Penny Ta r, Chairpers n
Dat4` Date: 5-'9 .111
Approve as t form and legality
Colleen A. Kerins
Assistant County Attorney
[21-CED-01551/1623681/1]