Backup Documents 10/12/2021 Item #16D 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP nn
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 U 6
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. Karina Bardales Community and Human 09/30/2021
Services
2. Jennifer Belpedio County Attorney Office
DQ)3. 10I I2 jai
3. BCC Office Board of County FC- ) �Q+� ��
Commissioners t
4. Minutes and Records Clerk of Court's Office
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/Grants Support Phone Number 239-252-2338
Contact/ Department Specialist/CHS Division
Agenda Date Item was October 12,2021 Agenda Item Number 16.D. (p
Approved by the BCC
Type of Document CWIF/Release of Lien.Prussian 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? �,�. p 0 .
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 KB
signed by the Chaiiivan,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 KB
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 KB
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 KB is not
the meeting have been incorporated in the attached document. The County -01:n foil
!6 .0
Attorney's Office has reviewed the changes,if applicable. his4luieJ
9. Initials of attorney verifying that the attached document is the version approved by the KB .. '';I it
BCC, all changes directed by the BCC have been made,and the document is ready for the le al01)it
Chairman's signature. ;,.e'
** Please e-mail a recorded copy to karina.bardales@colliercountyfl.gov**
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
16 06
INSTR 6144330 OR 6027 PG 3183
RECORDED 10/18/2021 8:58 AM PAGES 1
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
Prepared by:Maria Aldana REC$10.00
Collier County Community and Human Services
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 Deferral of 100% of Collier County Impact Fees for Owner Occupied Affordable
Housing Dwelling (the "Impact Fee Lien") executed by Carnicien Prussien and Anne Prussien, to
COLLIER COUNTY, recorded on 03/02/2009 in Official Records Book 4431, Page 1789 of the
Public Records of Collier County, Florida, in consideration of $27,907.45 ($22,325.96 plus
interest) having met the term 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 181, TRAIL RIDGE,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK
44, PAGES 71 THROUGH 77, 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 10 1.12-I 2,102,i
Agenda Item Number I l. .D • (,o .
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRY041 '" 4NZEL, CLERK COLLIER TY, FLORIDA
0' •'' 11,,,,;b1r .*% ,/4419 L3114-
• �.�..� � By:
•"' � +1P l� Y CLERK PENNY TAYLOR, CHAIRPERSON
ram,*
Approved for form and legality:
Je r A. Belpedio c\\Z
Assistant County Attorney