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Final Waiver of Lien <br />Stale oflndiana, County of s7� ��t✓�% SS, <br />being duly sworn that he/she. is the P Ale-,l A ewe <br />(Name of Officer) -- (Title) <br />Of 0—&S *')\-5tre� having contracted with Ar UV k <br />(Contractor) . (Owner) <br />to hmish certain materials and/or labor as follows; M kS ow (� <br />for a project known ast'.'.�•3 M 1qw} C�1 <br />located at <br />and owned by 15A <br />IM <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier; <br />(PARTIAL WAIVER) that there is due from the Contractor the suns of <br />Dollars ($ } <br />receipt of which is hereby aftowledged; or <br />Lam' 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 shalt be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAI M) that the final balan a du &pert e c actor is a sum of <br />:ate- D / � al l5 v •' <br />El receipt ofwhich is hereby actmowledged; or <br />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 tiro above -described property and improvements ents thereon an account Oflabor or Material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, irany, and fhrffier certified that: no other party has any claim or right to a <br />Ilea ou account of any work performed or material A mished to the undersigned for said project, and within the scope of this Affidavit <br />and Walver efLien. <br />9,Sy,.✓a-SOIJ ► t L C By <br />(Firm)'Authoxized sent <br />Repreative) <br />STATE OF iNMANA ( <br />) <br />SS; <br />ST, JOSEPH COUNTY <br />13efore me, the undersigned, a Notary Public, In and for said County and Slate, personally appeared �feye— e /dam <br />and aclaidwledged 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 3l day of <br />2' k_ <br />My Commissiont RXpires; I <br />Residing in J7 County, �rl <br />No ry PubIic Signature <br />i <br />1404W/9094I49". ROWN <br />NOTARY PUBLIC <br />S C-f1L. <br />STATES OF INDIANA <br />COUNTY OF ST JOSEPH <br />rJy C nniiss on Expires Jane 28, 2.021 <br />