Backup Documents 09/14/2021 Item #16D 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 0 8
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 eecat,A
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already cor ete 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. Maria Aldana Community and Human ,1 9/9/2021
Services
2. Jennifer Belpedio County Attorney Office 113 I
3. BCC Office Board of County
Commissioners J*ls/ 9' i4r )
4. Minutes and Records Clerk of Court's Office
YxA) girlie/6A °Pact4t-
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 Karina Bardales/Maria Aldana,Grants Phone Number 239-252-2338
Contact/ Department Support Specialist/CHS Div
Agenda Date Item was September 14,2021 Agenda Item Number 16.D.8
Approved by the BCC
Type of Document AHDB/Release of Lien.Jarstad Number of Original 1
Attached Documents Attached
PO number or account
number if document is 791-138791-649030-33686.1
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? S 1149 O V` MA
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 MA
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 MA
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's MA
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 above date and all changes made during MA N/A is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the MA N/A is not
BCC, all changes directed by the BCC have been made, and the document is ready for the o tion for
Chairman's signature. t
** Please e-mail a recorded copy to Karina Bardales/Maria Aldana**
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
1 60 8
INSTR 6130527 OR 6014 PG 2061
RECORDED 9/21/2021 9:29AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
Prepared by:Maria Aldana 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
Agreement for Affordable Housing Density Bonus (the "AHDB Lien") executed by Caroline A.
Jarstad to Collier County, recorded on 06/28/2006 in Official Records Book 4062, Page 2217, of
the Public Records of Collier County,Florida,in consideration of$0.00,receipt of which is hereby
acknowledged does satisfy, remise, release, quitclaim, exonerate and discharge the Affordable
Housing Density Bonus Agreement against the premises conveyed by said AHDB Lien and more
particularly described as follows:
UNIT 203, MORE PARTICULARLY DESCRIBED AS UNIT 4203,BOTANICAL PLACE,A CONDOMINIUM,
ACCORDING TO THE DECLARATION OF CONDOMINIUM THEREOF RECORDED IN OFFICIAL
RECORDS BOOK 3933,PAGE 2592,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. tt rr A
This Release of Lien was approved by the Board of County Commissioners on q 1 `t' IL()21 ,
Agenda Item Number 16.D. 2
ATTEST: - BOARD OF COUNTY COMMISSIONERS
CRYSTAL'K..KI1IZq, CLERK OF COLLIE COUNTY, FLORIDA
By: NU . /0/� ' 1,. By: .' L3‘1.
Attest 8b.to C to CLEg. ell, PENNY TAYL CHAIRPERSON
cignattire tly, ;
Approval for form and legality:
XR57
J: er A. Belpedio Q-f C`
Assistant County Attorney \'
CAO