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Final. Waiver 'of Lien <br />State ofIndiana, County of C, I I/— V <br />xA �r � <br />/.. i�.�" been dui sworn that�he/she is the C i:`. <br />(Name of ° ffloer) 'Title <br />�� �,- (Contractor) havingcontracted with ("1C) k Be <br />(Owner) <br />to Mmish certain materials and/or labor as follows, r :" - ° °' , ) , e" w <br />(Description) <br />for aproject ]mown as �„� N.� E e" f -rort -l" 'fid,( ,i"t" 1 J 10 _ <br />(Name ofProlect; <br />located at CA itrf .• <br />and owned by ,LID 1 St I Ai , i <br />(own") <br />and does hereby further ther state on the behalf ofthe aforementioned subcontractor/supplier. <br />(PARTIAL WAIVER) that there is due from the Contractor the sung of <br />Dollars <br />receipt of which is hereby aclatowledged, or <br />D the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver oflLienwhiolt 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) that the final balance due fk m the c ntractor the surd o <br />j receipt of which is hereby aclmowledged; or r:���(� "'� �' aboo <br />the payment of which has been promised as the sole consideration fortltis Affidavit and Final Waiver of Lien which shall <br />become effective only trponreceipt of such payment. <br />THEREFORE, the undersigned walvec and releases unto the Owner of sold promises, any and all hens 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 />thereto, subj cot to limitations or conditions expressed herein, if any; and h Aher certlfled that no other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for said "cot, and within the scope of this Affidavit <br />and Waiver of Lion. <br />{l;irni} "-- Authorized Representative) <br />STATE OF MIANA ) <br />SS. <br />STI JOSEPH COUNTY <br />13efore e, the undersigned, a Notary Public, In and For said. County and State, personally appeared °t. ne <br />IN WITNESS d the execution <br />of the foregoing Affidavit and Waiver of Lion, � � <br />and acknowledged the exIMIK OF, I have hereunto subscribed my name and affixed my ciao seal on the day <br />a of <br />otamy Publl ature <br />My Commission Expires: <br />��w'IVVI Itl <br />Residing in 6!,t:KCounty, I fQ I HA <br />`'SEA <br />i V <br />Notar MM <br />Ana <br />Elkhart courtly <br />Commission # 696906 i <br />My Commission Expires i <br />February 20, 2025 <br />