LEECOUNTYBOARDOFCOUNTYCOMMISSIONERS AGENDA ITEMSUMMARY BLUE SHEETNO: 200302314~~~

1. REQUESTEDMOTION:

ACTION REQUESTED: Approve @ml acce F

tance by Resolution and recording of one (I) Utility Easement as a donation ot seven water serv!ces, one 8” diameter Ire he and a gravity main extension serving the Daniels-Metro Park of Commerce. This 1s a Developer contributed asset project located on the northwest corner ot Damels l’arkway and Flantatlon Road.

WHY ACTION IS NECESSARY: To provide potable water service, fire protection and sanitary sewer service to the recently constructed commercial development.

WHAT ACTION ACCOMPLISHES: Places the tire line and sewer system into operation and complies with the Lee County Utlhtles Uperatlons Manual.

2. DEPARTMENTALCATEGORY: lo-UTILITIES COMMlSSIONDISTRlCT#: 2

5. REQUIREMENTIPURPOSE:

(SP@@Y) _ STATUTE _ ORDINANCE _ ADMIN. CODE x OTHER ser., E;lsemcn,

7. BACKGROUND:

( 3. MEETINGDATE: &,3d,,+,dd3

6. REQUESTOROFINFORMATlON:

A. COMMISSIONER: B. DEPARTMENT: c. DIVISION,SECT

Funds for recording fees are available in Account No. OD5360748700.504930.

SECTIONS 19 TOWNSHIP 45s RANGE 25E DISTRKT #2 COMMISSIONER ST CERNY

1. MANAGEMENTRECOMMENDATIONS:

9. RECOMMENDEDAPPROVAL

(D)

orma

RESOLUTION NO. _

RESOLUTION ESTABLISHING UTILITY ACCEPTANCE OF DEVELOPER CONTRIBUTED ASSETS

IN LEE COUNTY, FLORIDA

WHEREA;; i;aFe the desi t-e of ,McGregor Properties Parfnership, owner of record contn but1 on Lee County Utilities of water faci 1 iii es (one 8”a di ameter fi re lFie> , and m facilities (gravity co1 lection system) serving “DANIELS-METRO PARK OF COMMERCE”; and,

WHEREAS, Lee County Utilities requires proof of a Release of Lien, a Warranty (one-year) on all labor and materials, an accurate value of contributed assets,, and right-of-way and/or easement-indemnity granted for all systems being contributed to Lee County Utilities; and,

WHEREAS, all of the above information has been received and approved as complete by Lee county Utilities; and,

WHEREAS, Lee Count Commissioners that L

Utilities has recommended to the Board of county t e

operation, above-named system be accepted for ownership,

and maintenance.

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF LEE COUNTY, FLORIDA, that the above facilities, for a contributed value

of $21,225.00 is hereby ACCEPTED and acknowledged as an addition to Lee County Utilities.

THE FOREGOING RESOLUTION was offered by Commissioner who moved for its adoption. The motion was seconded by Commissioner

and, upon being put to a vote, the vote was as follows:

Commissioner Bob lanes : (1)

Commi ssi Oner Doug1 as St. Cerny: (2)

Commissioner Ray Judah (C): (3)

Commissioner Andrew Coy: (4)

Commissioner John Al bion (V-C) : (5)

DULY PASSED AND ADOPTED this 2003.

day of

AnEST: BOARD OF COUNTY COMMISSIONERS CHARLIE GREEN, CLERK OF LEE COUNTY, FLORIDA

By: By: DEPUTY CLERK CHAIRMAN

APPROVED AS TO FORM

OFFICE OF COUNTY ATTORNEY

l i: ,:“, ~~ ‘I; ~~ ,~I

LETTER OF COMPLETION

11.4

DATE: January 16,2003

Department ofLee County Utilities Division of Engineering Post Office Box 398 Fort Myers, FL 33902

Gentlemen:

This is to certify that the e distribution ana / 8~ B collection system (s) located in

DANIELS METRO PARK OF COMMERCE (Name of Development)

were designed by me and have been constructed in conformance with:

0 the approved plans n the revised plans, attached

H the approved specifications 0 the revised specifications, attached

Upon completion ofthe work, we observed the following successful tests ofthe facilities:

Water pressure tests and sewer Dressure tests, sewer viewer

Very truly yours,

Samuel W. Marshall. P.E. #48881

L

Project Manacler (Title) (SEW

711l96

PROJECT LOCATION

(,,, ” :‘,, “1 “Z” ;\ ,, 11.2

WARRANTY

THE UNDERSIGNED parties do hereby warrant and/or guaranty all work executed by the contractor on the water and/or

sewer systems of (Name of Development): Daniels Metro Park of Commerce

to be free from defects in material and workmanship for a period of one (1) year from the date of acceptance by the Lee County

Board of County Commissioners. The undersigned parties further agree that they will, at their own expense, repair and replace

all such defective work and all other work damaged by said defective work under this Warranty-Guaranty

It is furthermore understood that the consideration for the giving of this warranty and/or guaranty is the requirement by

the General Conditions and Specifications under which the contract was let that such warranty and/or guaranty would be given.

Lance Jackson Construction, Co.

Lance Jackson,

BY:

STATE OF Florida 1 ) ss:

COUNTY OF Lee )

The foregoing instrument was signed and a&no

I JO 02 by

sm -752 -lo,-acl,-ci (Type Of Identitication and Number)

as identification, and who (did) (did not) take an oath.

Tmi-“id (74 Notary Commission Number (NOTARY SEAL)

WARRANTY PAGE 1 OF 1 DANIELS METRO PARK OF COMMERCE S:WOBS\13xxll339\Documents\l339-LCU-Warranty-Jackson.doc

(,- ?I’ ‘\.~~.~,:y 1 ,

I )I :~~- ,;.

WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT

The undersigned lienor, in consideration of the final payment in the amount

- of k-% b~~~dS<,A 3WO1\J~fWLL~~-~~~~~$21,225. ‘a )

hereby waivers and releases its lien and right to claim a lien for labor, services, or

materials furnished to b&k-r 9% WL&P **sQw J J (insert the name of your customer)

to the following

(STRAP(s) #)

By: (Signature of&ho&d Representative)

By: Pw..Lc A L. S&s CL, ‘b K2J;h Qor. @-A (Print Name of Authorized Representative) (Address)

Title: qes x &-I& w k&-s fL 5331-i TCity, State &Zip)

Phone #: 234 - IL.1 - a!G I y Fax#: 235 -x1.7-O&I?

STATE OF COUNTY OF

The foregoing instrument was signed and acknowledged before me this &%$of fEA * - -2Ok?&zby -+?hWA.d .hvfi . d 9 who produced I’?& -/>~?/ka

,&z as identification or who is personally known to me, and wh

Anne L. Cygmi& Commission#DD[6~3~7 Evircs: NW 29,2006

Bonded Th,,, Adauic Bonding Co., ~nc.

Notary Public: (Signature)

Notary Public Name: A%$&/. A (Print)

(Forms-Waiver of Lien - Revised December 2002)

\, -,

CERTIFICATION OF CONTRIBUTORY ASSETS

11.5

PROJECT NAME: Daniels Metro Park of Commerce

LOCATION: 6300-6360 Techster Blvd.. Fort Myers. FL 33912

Strap #: 19-45-25-21-00000.0030 (Including STRAP)

NAME AND ADDRESS OF OWNER: I

McGregor Properties Partnership

15051 Tamiami Trail South, Suite 203; Fort Myers. FL 33908 (as shown on Deed)

TYPE UTILITY SYSTEM: Water (list water, sewer and effluent reuse separately)

DESCRIPTION AND COST OF MATERIAL, LABOR. AND SERVICES

Please list each element of the system, e.g., pipe, manholes, lift stations, meters, valves, fittings, etc

ITEM SIZE QUANTITY UNIT COST TOTAL

Hot Tap IO” x 8” 1 Each $3,500.00 $3.500.00

5’ Fire line UD to 8” 1 Each $1580.00 $1580.00 including I” OS&Y valve

Double Service to Meter Box 1" X ?‘a” (inc. removal of sinqle service\

3 Each $500.00 $1.500.00

Sinqle Service to Meter Box 1" 1 Each $450.00 $450.00

$7,030.00 TOTAL AMOUNT

LCD"Man -September 19,2001

DANlELS METRO PARK OF COMMERCE PAGE 1 OF 2 CERTIFICATE OF CONTRIEUTORY ASSETS S:VOBSl13xxl1339lDocumentsll339-LCU-Cert of Contrfb Assets-Water.doc

11.5

I do hereby certify that the quantities of material and services described above are a hue and accurate representation of the as-installed cost of the system being contributed to Lee County and corresponds with the record drawings.

CERTIFYING:

Richard Lance Jackson, President lName &Title of Certifying Agent)

OF: Lance Jackson Construction (Firm or Corporation)

ADDRESS: 16880 Gator Road

Fort Mvers, Florida 33912

STATE OF Florida 1 ) ss:

COUNTY OF Lee )

The foregoing instrument was signed and acknowledged before me this 7th

day of February ,20 03 by Richard Lance Jackson (Print or Type Name)

who has produced identification,

Florida Driver’s License #5250-752-61-206-O k3S

(Type Of Identification and Number)

and who (did) (did not) take an oath

Marv C. Gaqnon Printed Name of Notary Public

(NOTARY SEAL) DD087084

Notary Commission Number

DANtELS METRO PARK OF COMMERCE PAGE 2 OF 2 CERTIFICATE OF CONTRtEUTORYASSETS S:UOBS\13~XI1339iDocu~ents~1339-LCU-Cerf of Contdb Assets-Water.doc

,L k,/-.,, I:, ~', !, 11.5 1 CERTIFICATION OF CONTRIBUTORY ASSETS

PROJECT NAME: Daniels Metro Park of Commerce 6300-6360 Techster Boulevard

LOCATION:Formerly 13320 Plantation Road: Fort Myers. FL 33912 strap #19-45-25-21-00000.0030

Formerly Strap #: 19-45-25-00-00002.0060 (Including STRAP)

NAME AND ADDRESS OF OWNER: McGreaor Properties Partnership I

15051 Tamiami Trail South, Suite 203: Fort Myers, FL 33908 (as shown on Deed)

TYPE UTILITY SYSTEM: 5 Ptiw- (list water, sewer and effluent reuse separately)

DESCRIPTION AND COST OF MATERIAL, LABOR. AND SERVICES

Please list each element of the system, e.g., pipe, manholes, IiA stations, meters, valves, fittings, etc.

ITEM SIZE QUANTITY UNIT COST TOTAL

Pkv\h\ t w I EA P&P~ 5000, =

w-21, NC L1 qQ3 LF i-j- dors.=- Cl P L.y? WJ t I.#" 7 E-n 356% lY50.6J- r&1-\, 94 c L“ -ICI L-l= , $2 7&y

9i4, /w"" TOTAL AMOUNT

LCDUMan - September 19,201

DANtELS METRO PARK OF COMMERCE CERTIFICATE OF CONTRIBUTORY ASSETS

PAGEIOFZ S:UOBS\13xx\l339\Documents\l339-LCU-Cert of Contrib Assets-Sewer.doc

I 11.5

I do hereby certify that the quantities of material and services described above are a true and accurate representation of the as-installed cost of the system being contributed to Lee County and corresponds with the record drawings.

(Name & Title of Certi

STATE OF )

COUNTY OF

The foregoing instrument was signed and acknowledged before me this

day of J@- by (;&pPC &flee ~fjyCb0~ (Print or Type Name)

who has produced 3&,&B, [w 2!!4&%& ~-2~5 - 7 sa-&.W~ as identification,

(Type Of Identification and Number)

and who (did) (did not) take an oath

(NOTARY SEAL)

DANIELS METRO PARK OF COMMERCE PAGE 2 OF 2 CERTIFICATE OF CONTRIBUTORYASSETS S:VOBSl13xxl1339lDocumenlsl1339-LCU-Cs~ of Contrib Assets-Sewer,doc

This Instrument Prepared By: Lee County Utilities

1500 Monroe Street - 3’d Floor Fort Myers, Florida 33901

PERPETUAL PUBLIC UTILITY EASEMENT GRANT

THIS INDENTURE is made and entered into this _ day of ., 2003, by and between McGreqor Properties Partnership , Owner, hereinafter referred to as GRANTOR(S), and LEE COUNTY, hereinafter referred to as GRANTEE.

WITNESSETH:

1. For and in consideration of the sum of TEN DOLLARS ($10.00) and other good and valuable consideration, the receipt of which is hereby acknowledged and accepted, GRANTOR hereby grants, bargains, sells and transfers to the GRANTEE, its successors and assigns, a perpetual public utility easement situated in Lee County, Florida, located and described as set forth in Exhibit “A”, attached hereto and made a part hereof.

2. GRANTEE, its successors, appointees and assigns, are granted the right, privilege, and authority to construct, replace, renew, extend and maintain a wastewater collection and/or water distribution system, together with, but not limited to, all necessary service connections, manholes, valves, fire hydrants, lift stations and appurtenances, to be located on, under, across and through the easement which is located on the property described (Exhibit “A”), with the additional right, privilege and authority to remove, replace, repair and enlarge said system, and to trim and remove roots, trees, shrubs, bushes and plants, and remove fences or other improvements which may affect the operation of lines, mains and/or utility facilities.

3. The public utility easement shall not be limited to any particular diameter size or type and/or number of connections to other water/sewer mains for providing water/sewer service to this and any adjacent properties. The total area of this public utility easement is reserved for utility lines, mains, or appurtenant facilities and for any landscaping (excluding trees), walkways, roadways, drainage ways, or similar uses. Houses, fences, buildings, carports, garages, storage sheds, overhangs, or any other structures or portions of structures shall not be constructed on or placed within this easement at anytime, present or future, by GRANTOR, or its heirs, successors or assigns.

4. Title to all utilities constructed and/or placed hereunder by GRANTEE or its agents shall remain in the GRANTEE, GRANTEE’s successors, appointees, and/or assigns.

5. Subject to any pre-existing easements for public highways or roads, railroads, laterals, ditches, pipelines and electrical transmission or distribution lines and

(Forms-Perpetual Public Utility Easement - LCU County Attorney Approved Form 1012002 -Page- 1 of 3)

telephone and cable television lines covering the land herein described, GRANTOR(S) covenant that they are lawfully seized and possessed of the described real property (Exhibit “A”), have good and lawful right and power to sell and convey it, and that the said property is free of any and all liens and encumbrances, except as herein stated, and accordingly, GRANTOR(S) will forever defend the title and terms of this said easement and the quiet possession thereof by GRANTEE against all claims and demands of all other entities.

6. GRANTOR(S), its heirs, successors or assigns, shall assume all liability for any consequential damages to any houses, fences, buildings, carports, garages, storage sheds, overhangs, or any other structures or portions of structures subsequently constructed by GRANTOR(S) in violation of paragraph 3 within the above easement, which result from the required activities of the GRANTEE for any construction, maintenance or repairs to the utilities located within the above-described easement.

7. GRANTEE will be liable for money damages in tort for any injury to or loss of property, personal injury, or death caused by the negligent or wrongful act(s) or omission(s) of any official or employee of the GRANTEE while acting within the scope of the official’s or employee’s office or employment under circumstances in which a private person would be found to be liable in accordance with the general laws of the State of Florida, and subject to the limitations as set out in Section 768.28, Florida Statutes, as it may be revised, amended or renumbered from time to time.

8. GRANTEE shall have reasonable right of access across GRANTOR’s property for the purposes of reaching the described easement (Exhibit “A”) on either paved or unpaved surfaces. Any damage to GRANTOR’s property or permitted improvements thereon as the result of such access to the described easement or the construction, maintenance, or repairs located within the described easement shall be restored by GRANTEE, to the condition in which it existed prior to the damage as is reasonably practicable. GRANTEE agrees to coordinate each activity within the easement premises in advance with the manager of the U. S. Postal Service, so as not to interfere with Postal Service operations.

9. By acceptance of this easement, the GRANTEE assumes no responsibility for ownership or maintenance of any associated roads. The easement is strictly for utility purposes. If GRANTEE fails to utilize the granted easement (Exhibit “A”, hereto) for the purposes as set out herein and for the time as set out in Section 255.22, Florida Statutes, then this easement shall be extinguished pursuant to law,

10. This easement shall be binding upon the parties hereto, their successors in interest and any assigns.

(Forms - Perpetual Public Utility Easement - LCU - County Attorney Approved Form 1012002 - Page- 2 of 3)

IN WITNESS WHEREOF, the GRANTOR has caused this document to be signed on the date and year first above written.

(Grantors/Owner’s Signature)

1°C: (Grantors/Owner’s Name)

McGregor Properties Partnership

Authorized Representative Title

& ( I ).S Managing General Partner

(Name of 2”d Witness)

STATE OF FjloH&, 1

COUNTY OF xu/ )“,“:

ned and acknowledged before me thishA day who has produced the following as identification -

, and who did not take an oath.

(Notary Seal & Commission Number)

Professional Engineers, Planners 8 Land Surveyors FORT MYERS . NAPLES . SARASOTA

DESCRIPTION OFA

PARCEL OF LAND LYING IN

SECTION 19, TOWNSHIP 45 SOUTH, RANGE 25 EAS’I LEE COUNTY. FLORIDA

(PUBLIC UTlLlTY EASEMENT)

A TRACT OR PARCEL OF LAND SITUATED IN THE STATE OF FLORIDA, COUNTY OF LEE, LYING IN SECTION 19, TOWNSHIP 45 SOUTH, RANGE 25 EAST, LEE COUNTY, FLORIDA, BEING A PORTION OF LOT 3, PLANTATION COMMERCIAL PARK, AS RECORDED IN PLAT BOOK 72, PAGES 35 AND 36, PUBLIC RECORDS OF SAID LEE COLINTY, FLORIDA, BEING FURTHER BOUND AND DESCRIBED AS FOLLOWS:

COMMENCING ATNORTHWESTCORNER OF SAID LOT3; THENCE S.00°53’10”W. ALONG THE WESTERLY LINE OF SAID LOT 3 FOR 210.47 FEET; THENCE S.S9%‘50”E. FOR 173.45 FEET TO TI-IE POINT OF BEGINNING; THENCE N.8X058’50”E. FOR 30.00 FEET; THENCE S.Ol”Ol’l I-E. FOR 72.00 FEET; THENCE N.88’58’49”E. FOR 107.70 FEET: THENCE N.OIQOI’I 1-W. FOR 5.00 FEET; THENCE N.88O58’49”E. FOR IO.00 FEET; THENCE S.OIDO1’l 1-E. FOR 5.00 FEET; THENCE N.88°58’49”E. FOR I I .50 FEET TO AN INTERSECTION WITH THE WESTERLY LINE OF A 20’ PUBLIC UTILITY AND LAKE MAINTENANCE EASEMENT AS SHOWN ON THE PLAT OF SAID PLANTATION COMMERCIAL PARK; THENCE S.0I~01’16”E. FOR 30.00 FEET DEPARTING SAID WESTERLY LINE AT 18.81 FEET; THENCE S.88”58’4Y”W. FOR 129.20 FEET: THENCE S.OI”Ol’l I”E. FOR 82.66 FEET: THENCE N,88”58’49”E. FOR 5.00 FEET; THENCE S.OlOOl’l I”E. FOR 10.00 FEET; THENCE S.X8”58’49”W. FOR 5.00 FEET; THENCE S.Ol”Ol’l I”E. FOR 127.38 FEET; THENCE N.8X058’49”E. FOR 5.00 FEET; THENCE S.OI ‘01’1 I”E. FOR 10.00 FEET: THENCE S.SX”58’49”W. FOR 5.00 FEET; THENCE S.OlOOl’l I”E. FOR 24.96 FEET; THENCE S.S8”58’5O”W. FOR 30.00 FEET; THENCE N.0l”Ol’l I”W. FOR 357.00 FEET TO THE POINT OF BEGINNING.

PARCEL CONTAINS 0.34 ACRES, MORE OR LESS.

SUBJECT TO EASEMENTS, RESTRICTIONS, RESERVATIONS AND RIGHTS-OF-WAY OF RECORD,

ASSUMED NORTH BASED ON THE WESTERLY LINE OF LOT3 PLANTATION COMMERCIAL PARK AS RECORDED IN PLAT BOOK 72, ATPAGES 35 AND 36 OFTHE PUBLIC RECORDS OF LEE COUNTY, FLORIDA AS BEARING S.00°53‘Io”W.

DESCRIPTION PREPARED DECEMBER 12.2002 DESCRIPTION REVISED JANUARY IS. 2003

R w&w-Ad rn. K~ARD M. R?~Z

“y REGISTERED LAND SURVEYOR FLORID% CERTlF!CATION NO. 40 9

SHEET I OF 2

IO51 I Six Mile Cypress Pkwy, Sdte 101. Ft Myers. I~londa 333912 l (!)41) 939-54X1 l b’ax fl41) 1)3!1-‘2923

/ /’ /

111111 lllllllII FLORIDA DEPARTMENT OF REVENUE PHOTOCOPIES OF w-210

RETURN FOR TRANSFERS OF INTEREST IN REAL PROPERTY THIS FORM NOT ~07198

ACCEPTABLE (PLEASE READ INSTRUCTIONS ON THE BACK OF THIS FORM BEFORE COMPLETING)

Use black ink. Enter numbers as shown below.

1. Parcel Identification Number (If Parcel ID not available

~;;:~~!E;:~ Ypelty

2. Mark(x) all that apply

Multi-parcel 0

Transaction is a split Propelly was improved or c”tout from

transaction? --) -0 with building(s) at time

another parcel? Of saleitransfer? -0

3. Grantor (Seller,: MCGREGOR PROPERTIES PARTNERSHIP

Last First 15051 TAMIAMI TRAIL SOUTH, FT. MY%.S FL 33908

Corporate Name (if applicable)

(

i Mailing Address

) City State Zip Code Phone NO.

4. Gmtee(Buyer): LEE COUNTY BOARD OF COUNTY COMMISSIONERS Last First MI

P. 0. BOX 398, FT. MYERS FL 33902 Corporate Name (if applicable)

Mailing Address

(239, 479-8181

5. Date Of Salerrransfer City State Zip Code Phone NO.

Sale~Transfer Price

DONATION (Round lo the nearest dollar.) Yluu~ou~uu. m

8. TO the best of your knowledge, were there unusual circumstances or conditions to the sale/transfer such as: Forced Sal8 by court order? Foreclosure pending? Distress Sale? Xtle defects? Corrective Deed? Mineral rights? Sale Of a partial or undivided interest? Related lo seller by blood or marriage. YE& / c]NO

9. Was the sale/transfer financed? YES u/u NO If “Yes”, please indicate type or types of financing:

Conventional 0 Seller Provided 0 Agreement or Contract for Deed q I? Other

Institutional/ 10. Property Type: Residential Commercial Industrial Miscellaneous Government VaCWlf

Mark (x) all Agricultural Acreage Timeshare

that apply cl eun q 0 0 q 0 11. To the best of your knowledge, was personal p,operty

included in the sale/transfer? If “Y& please state the YESu/uNO $

csnts

amount attributable to the personal p 12. Amount of Documentary Stamp Tax

13. If n&L&x is due in number 12, is deed exempt from Documentary Stamp

q ou~On~oo. DID mn~Ocl~no. on

201.02(6), Florida Statutes? YE& / ON0 Under penalties of perjury I declare that I have read the foregoing

L than the taxpayer. his/her declaration is based on ail information 0

Signature of Grantor or Grantee or Agent

WARNING: FAILURETO FILE THIS RETURN ORALT OTHER PENALTY IMPOSED BY THE REVENUE L&IV

r , I

(To be completed by the Clerk of the Circuit Court’s O&a) Clerks Date Stamp

C lateRecorded 00 / 00 / nrlnn Month Day Year

,” ,,,, _r___\,-__rn”--..r..-^r^-..-.,..----.-- ““nllcb”rr I” “crevi,MCNI UT ne”tN”t “PHIA CANARY COPY TO PROPERTY APPRAISER

O. Ra;ly uuuuu

Page Number cluoe

File~~ber ueuouuuuceouu

FeeTransmiital Form 281-l Rev12193

TO: LEE COUNTY FINANCE DEPARTMENT

FROM: UTILITIES ENGINEERING (Department)

SUE GIJLLEDGE A. AUTHORIZATION: BS 20030231-UTL

This tran$mittal authorizes the UTIL. ENGINEERING

office to incur expenses for filing/records against: N/A DANIEL%METRO PARR OF COMMERCE (MCGREGOR PROPERTIES

Purchase Order # for project. ACCOUNT NO. OD5360748700.504930

PTRNSP)

ORIGINAL EASEMENT TO MINUTES AFTER RECORDING, WITH COPY TO SUE GULLEDGE, UTILITIES

Sigffature Authorization

6. SERVICE RECEIVED: RECORDING

0. R. COPIES

PLAT COPIES

CASE #/INDEX FEE

DESCRIPTION OF SERVICE

AMOUNT OF FEE INCURRED $

(date) (DEPUTY CLERK)

(CUSTOMER) (DEPT.) THIS FORM GOES TO CASHIER WITH REGULAR RECEIPT ATTACHED

d. INVOICE INFORMATION: (FOR CLERK’S DEPARTMENT ONLY)

REC’D

ENTERED

CUST. #

INV. #

PLEASE REMIT TO: Clerk’s Accounting P.O. BOX 2396 FORT MYERS, FLORIDA 33902.2396 White. FINANCE Yellow DEPT FlSCAL OFFlCER Pink. CLERK’S OFFICE