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Final Waiver of Lien <br />Stale of Jndlana, County of )SE101"I SS: <br />I (�'I�tvl being duly sworn that lielshe Is the <br />(Name of Officer) ('Title) <br />Of hav ng contracted with <br />(Contractor) (Owner) <br />to furnish cettain materials, and/or labor as follows,, <br />for a project known as <br />located at <br />and owned by <br />S c') <br />and does hereby further State on the behalf of the aforementioned subcontraotor/supplier: <br />(PARVAL WAIVER) that there is due from the Contractor the sum of <br />Dollars 0 1 <br />D receipt of which is hereby aolmowledged; or <br />El the payment of which lies been promised as the Sole consideration for this Affidavlt and Final Waiver of Lien -which is given <br />solely with respect to said amount, and which waiver Shall bo effective. only upon receipt of payment thereof by the <br />undersigned; <br />(MALWAIVER)tbalth, al balance due froin the co itractor Is the sum of <br />j JJr� )� _ vc.a huLC1,vcJ y) <br />d t J d Z"3'99'5,o <br />El receipt of which Is hereby acknowledged; 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 the above -described property and Improvements thereon an account of labor or material or bath, <br />furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />Ron on account of any work perfornied or material furnished to the undersigned for said project and within the scope of this Affidavit <br />and Waiver of Lien. <br />By <br />STATE OF INDMNA (Fhm) (Authorized Representative) <br />SS. <br />ST. JOSEPH COUNTY <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared <br />and aftowledged the execution of the foregoing AffidavIt. and Waiver of Lion, <br />IN WIT ESS WHEREOF, I have hereunto subscribed my name and affixed my officink"se I op,° day of <br />200 L2(L) <br />NoUbl <br />pfros: <br />My Conimfsalon EX C)011 <br />Residing in county, <br />Notary.Publio Nome <br />