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Final Waiver of Lien <br />State ofXruiiana, County of _ ) (-[.. � y-� SS, <br />Ca • J�Fxcry being duly sworn th4 she is the P44-S I <br />(Name of officer) (Title) <br />of No&ttt ' 414►+k Qooh,+s- having contracted With aI N or- J'o«r W 4..aA <br />(Contractor) (Owner) <br />to h nlsh certain materials and/or labor as follows; 2po F A^U 44 *'JA keptA Gtyy Ew f <br />(Description) <br />for a project known as N r• yy,, C jrV j-j�x, (Z.aF /4-PAI - <br />(Natne Of>7raject) <br />located at fo <br />and owned by <br />(Owner) <br />and dogs hereby further state on the behalf ofthe aforementioned subcontractor/oupplfer: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars — <br />❑ receipt of which is hereby aoinzowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver oft fen -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 WAIVER) that the final balance due from the contractor is the sum of <br />❑ receipt ofwluch is hereby acknowledged; or <br />[� the pay►neat of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective onlyuponnoeipt of such payment. <br />TIM1113FORE, the undersigned waives and releases unto the Owner of said premises, any and all lions or claims whatsoever <br />on the above -described property and improvements thereon at 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 thatno other party has any claim or right to x <br />Tien on account of any work perfiolmod or maternal furnished to the undersigned for saidproject; and within the scope of Us Affidavit <br />and WaiverofLlen. <br />(Finn) (Authorized Re entative) <br />STATB OF WOA <br />) SS: ` SR <br />ST, JOSEPH COUNTY } <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared44'�� E..') <br />� � G,� C <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. r <br />IN WITNESS OF, I have hereunto subscribed my name and affixed my official seq on the day Of <br />o roblio Signature <br />My CommissionExpfros: <br />(j o e) i � <br />Residing in <br />County, L <br />Notary Public Name <br />i <br />