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Final Waiver of Lien <br />State ofindlana, County of SS: <br />being duly sworm <br />s f _ ► that he/she is the We's y ci'e^^ — <br />(Name of OfficerY)! - (Title) <br />of S vv'"e'`�L�! / having contracted with _C_ ► 'Y o v " <br />(Cantractax) T (Owner) .""°.... <br />to Tarnish cortala materials and/or labor as follows: 2+1/ �7+t' D� t2 tt �4-/-e:.1-S <br />(Description) <br />for a project known as <br />located at <br />and owned by <br />1. e- 14 z'Gw) 4) [+L►A- / At � e <br />?nJ <br />0"'� I <br />and does hereby further state on the behalf ofthe aforemenfloned subconttactor/supplier, <br />(PARTIAL WAPAW that there is due from the Contractor the sum of <br />Dollars <br />Q receipt of which is hereby aolsnowledged; or <br />[� the payment of which lies been promised as the sots consideration for this Affidavit and. Final Waiver ofLien-which is given <br />solely with respect to said antouat, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />AL VAI'V124) thatJhe final due from the contractor is the am of <br />❑ receipt ofwhieh is hereby acknowledged; or <br />E3'/ the payment of which has boon promised as the sole consideration forthis Affidavit atnd Final Waiver of Lien which shall <br />became 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 tho above-deserlbed 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 certMed ihatno other party has any claim or right to it <br />Ron on account of any work per£coned or material famished to the undersigned for said projec4 and within the scope of this Affidavit <br />and Waiver ofLlen. <br />(Fi(Authorized Representative) <br />STATE OF iNDU1d+lA ) <br />SS: <br />ST. J'OSEPH COUNTY <br />Before me, the undersigned a Notary Public, in and for said County and State, personally appeared � /Li � )J--5 <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS OF, I have hereunto subscribed my name and affixed my official seal on the day of <br />Notary Public Signature <br />MyCon=fsafoftExpires: -sue4/i L' <br />Residing in County, No pubi#o Name- <br />dRSFf/1 �, f3��OWN <br />NOTARY PUDLIC <br />SEAL. <br />STATE OF INDMA <br />COUNTY OF ST JOSI_:PH <br />Illy n�rhriii� yiUn Fx��fr�3s,l�ane �B ?02 <br />