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Final Waiver of Lien <br />State of7ndiana, County of St. Joseph SS, <br />Rachelle L. Dolniak being duly Sworn ihathelsheisthe President <br />(Name ofOffioer) (Title) <br />of Ritschard Bros., Inc. haft contracted with City of South Bend <br />(Contractor) (Owner) <br />tofurnish cettaitzrrmterislsandlorlaborasfollows, Demolition <br />(Description) <br />for aprojeetlsnDmuas 2017 Demolitions, Phase 1, Division A & C <br />(Name of)'rojeat) <br />located at 3602 W. Western Avenue, South Bend, IN <br />and owned by City of South Bend <br />(Owner) <br />and does hereby further state on the behal£ofthe aforementioned subcontractor/supplier, <br />(PARTIAL WAIVER) Cat there is due, from tIle Contractor the sum of <br />Dollars _{� } <br />Q receipt of which is hereby acktzowiedged, or <br />D the payment of which has been promised ns the sole consideration for this Affidavit arid. Final Waiver ofMeawhich is given <br />solely with respect to said amount; and which waiver shall be effective oatly upon receipt ofp" meet thereofby the <br />undwsigned; <br />(FINAL WAIVER) drat the final balance due from the contractor is the Bum of <br />Twelve Thousand Forty—five Dollars and 10/100 <br />[ receipt ofwbleh is hereby acknowledged, or <br />XL� thePAYMent of whlohhas boonpromisedus the sole Affidavit andFinal Waiver of Liellwhi0h shall <br />income effective only upon.xeceipt of such payment. <br />TBEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above-doscribed property and improvements thereon a' nomimt of labor or material or bout, flan#shed b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any, and furthcr cortlfied thatno outer party has any claim orright to a <br />lien on acccuat of any wank perf4ormed or material furnished to the undai ed for saldp roject, and within the scope of this Affidavit <br />and WaiverofLien. <br />Ritschard Bros., Inc. BY <br />irma"k - <br />(Authorized Representative) <br />STATE OF INDMNA ) <br />) SS: <br />ST. IOSEPH COUNTY ) <br />Deforo me, the undersigned, a Notary public, in and for said County and State, personally appeared Ra the I le L . Do In i ak <br />and admowlcdged the execution of the foregoing Affidavit and Waiver of Lion. IN WITNESS WIUMOF, Ihays hereunto subscribed my name and affixed my offic`a cal the 3 h day of <br />November 20I7 , �rl2 <br />G�p.RD @ROSi,�� . otary Public Signature <br />5 <br />My Commission Expires; 9 / 1 S / 25• : , ' T <br />' Robin Fozo <br />Residingin St. Joseph _ County, r Indiana — — blataryPnbiioNaz❑e <br />•,/'�� OF i N��P`��`` <br />