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Final Waiver of Lien <br />State ofkdiana, County of I , SS: <br />being duly sworn thathelshe is the &J-r <br />gismo ofOfficer) <br />(Title) <br />Of Qf . 1 VD544,Pjd_4_ having contracted with & TY �_ _�_ CJlJG�7 H � ►� 17 <br />(Contractor) DeS l(g1J (Owner) ~� <br />to :lhmish certain materials and/or labor as follows; 1 a'<Cog- 10i, ni'�'�,�il�e <br />(Description) _ <br />for a project known as <br />and owned by <br />04 <br />(Name <br />and does hereby further state on the behalfofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars _($_ ) <br />❑ receipt of which is hereby aelutowlodged; or <br />❑ the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver of Lienwhich 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) Lb t the final bal ce due from the contractor is the sum of <br />_a/1606. oo ) <br />Q receipt of which is hereby acknowledged; or <br />the payment of which has been promised as the sole consideration for this Affidavit and Mnal Waiver of Lien which shalt <br />become offeotive only uponreceipt of such payment. <br />THEREF0RE, the undersigned waives and releases unto the Owner of said premises, any and all lions or claims whatsoever <br />on the above-deserlbed property and improvements thateon an account of labox or material or both, furnished b the ten igued <br />thereto, subject to limitations or conditions expressed herein, ffany; and further cart no other party has an aien ox rie�ht to <br />Kett on account of any work performed or material famished to the undersigned saidpr ect, and wlthin the ope oftbis A13Cdav <br />Jana WalverofLlon. <br />(Firm) (Author; d Representative) <br />STATE OF 1NDIANA ) <br />SS: <br />ST. JOSEPH C0UNT1C ) <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared <br />and acdmowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNJ SS WMEOF, I have hereunto subscribed my name and fixed my o al seal on the 2-9 day of <br />b V.9m a-2 - 200 <br />otary Public Signature <br />My Commission Expiros; J�?L � ' Z 0 Z V <br />Residing ht aL 5 n?-A County, -- -- - ll4 b.J kq <br />OFFOAL SEAL <br />ALICE M. McKINLEY <br />NOTARY PUBLIC - INMANA <br />ST.JOSEPH COUNTY <br />My Comm. Expires 9/2612024 <br />