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Final Waiver of Lien <br />State oflndiana, County of V, J e,5-14 SS; <br />1-14ru lcl Ate;"h ke being duly sworn that halsheisthe <br />(Name of Officer) Title <br />of IC �rn �r . L n c . having contracted with 0 -'5;"kk %j " <br />(Contractor) (Owner) <br />to :furnish certain materials and/or labor as follows; <br />for it project known as <br />loosted at A'-4 J! . <br />and owned by <br />and does hereby further state on the hchaif ofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars _ (S_ „ . ... . .. ......... <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 sball be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAI V ) that the final balance due from the contractor is the sum of <br />❑ receipt of -which is hereby acknowledged; or <br />Mite payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lien which shall <br />beoatne effective only upon roccipt of such payment. <br />TFIEREFORE, the undersigned waives and releases unto the Owner ofsaid 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 />tharolo, 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 perfortned or material furnishedto the unders ecl-fer-said jec;zn within the scope o£this Affidavit <br />and Waiver of Lion. <br />f o J 0 -"�`�� �• Tataneshia <br />(Finn) :� °n Comm. Expires Aug. 31, 2023 Authorized Representative) <br />STATE OF MIANA <br />Resides in S. Joseph Co., IN <br />ST,]OSSPIICOUNTY ) SS: Comm. Number 672377 <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared HCurDdReAAM <br />and aolatowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />WI LASS WHEREOF, I have hereunto subscribed my name and affixed M=i' <br />Z1S d of <br />ayzoa �� M.. <br />Notary Public Signature <br />MyConunissionBxpiros: � ~ <br />Residing in, J County, _ i l ._ Notary Public Name <br />