Laserfiche WebLink
Final Waiver of Lien <br />i <br />State oflndiana, County of __ �� ��fj � Ss' <br />s -(tr,)e, L "'J being duly sworn that he/she is the 2 ,5,� td� <br />(Name of Officer) Title <br />of "S N45-9v�j having contracted with (il ,{ <br />(Contractor} -� , J (Owner) <br />to Aimish certain materials and/or labor as follows; C'" S7'��" �' ��'"` I0 H>q ' �Z ✓►1 <br />(Description) <br />for a project known as <br />located at Z-4e,ff i <br />and owned by <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that Cher$ is due from the Contractor the sum of <br />Dollars _M ? <br />❑ receipt of which is hereby aoknowledged; or <br />❑ the payment of which has boon promised as the sole consideration for this Affidavit and Final Waiver of Lien -which is given <br />solely/ with respect to said avaount, and which waiver $ball be effective only upon receipt of payment thereof by" <br />undersigned; <br />koln the t�tor is the sum of , ��0 ' �11 <br />(s l <br />❑ receipt ofwbich is hereby acknowledged, or <br />thepaymeat 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 tho Owner of said promises, any and all lions or claims whatsoever <br />on tho above -described property and improvements thereon as account of labor or material or both, furnished b the undersigned <br />therolo, subject to limitations or conditions expressed herein, if any; and norther certified thatno other party has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned for said -project and witbht the scope ofthis Affidavit <br />and Waiver of Lien. <br />[ LAC, By t.PSf� <br />ntin / (Authorized Representative) <br />STATE OF INAIANA ) <br />SS: <br />ST, JOSEPH COUNTY j r <br />Before me, the undersigned a Notary Public, In and for sold County and State, personally appeared <br />and aftowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WIBREOF, Ihave hereunto subscribed am` and affixed myofficialseal on the 1 day of <br />Notary Public Signature <br />My Commission Expires: �'Ag Z <br />Residing in k. county, Notary mil/-1�2Public Na R <br />- S)E-EA L. BROWN <br />NMARY PUDLiC <br />£�F /4L_ <br />STA F O?: iNDMA <br />COIJf"i i Y 0;- :;7 JOSE PH <br />NAy corn 'Jssion Ex;�ires June 28 2021 <br />