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AFFIDAVIT AND WAIVER OF LIEN <br />State of Indiana, County of ST. -5Cr1>Q �k SS: <br />being duly sworn that he/she is the 0 `(_e_ PR �S tdl r' <br />(Name of Officer) (Title) <br />of C'. S M\45c,�Mj Re.--Tcs.-tk-V' (((having contracted with Ns m—,-Sew✓y kes-ro.,y}7,aJ LCC. <br />(Subcontractor/Supplier) ontractor) <br />to furnish certain materials and/or labor as follows: 'YeJar LN5T�LLh-r oti <br />(Description) <br />for a project known as Okocv%-- �Lcr j e-4i_ee zkA- ot): lllp-D7� <br />(Name of Project) <br />located at p(>iJC'��LO�j C T , SE9l{ i� e!V <br />and owned by Robe - <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />❑ receipt of which is hereby acknowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL <br />from the contractor is the sum of <br />600, <br />❑ receipt of which is hereby acknowledged; or <br /><y the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lien. <br />CAS ia9lZSi+r/+z+/ %8s7 g,7r arm LLC, By 424 <br />(Firm) (Authorized Representative) <br />STATE OF INDIANA ) <br />SS: <br />ST. JOSEPH COUNTY ) // <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared < �.. f E n e 1 r1 S <br />and ackmowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the day of <br />240ja_L] <br />DONNASGROVES <br />:Notary Pijhli,DONNA <br />c....,. _. �_..__ otary Public Signature <br />`JC�IlI�i� J `5��11�5 <br />Notary Public Name <br />