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Final Waiver of Lien <br />State ofhdiana, County of + i T. �4� G/°� SS: <br />tT ,�� ,Z TJ'•C being duly woruthathelshe is the <br />(Name of Officer) (Title) <br />of having contracted with Gfi7 d U <br />(Contractor) (Owner) <br />to famish certain materials and/or labor as follows; <br />for a pro eat ianawn as �I1 <br />located at &f ,� 0, <br />and ovmed by U T 4.f, tl' 067-� d bl" <br />and does hereby Author state on the behalf ofthe aforementioned subcoatractor/supplier; <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />receipt of which Is hereby solmowledged; or <br />:DA J GII_ROYM1fUbjl�, State of IndianaSEAT "JoaephCountymission ri $29192mmission Ex iresgu3 <br />(j the payment of which line been promised as the sole consideration for this Affidavit and Filial Waiver ofLieznwhich is given <br />solely with respect to said amount, and which waiver aball be etTectiva only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVM that the final balance due fora the contractor Is the sum of <br />[l receipt of which is hereby aolmowledged; or <br />the payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lien which shall <br />become offective onlynponreceipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of sold <br />on the above -described property and improvements thereon an account of labor orrn <br />thereto, subject to limitations or conditions expressed herein, if any; and Rather ca <br />lion on account of any work perforined or material 11 mished to the undersigned s <br />and Waiver of Lien. <br />BY <br />(gam) <br />Alm% any and all liens or claims whatsoever <br />:al or b4b, hmished b the undersigned <br />that no Cher party has any claim or right to a <br />�rojee and within the scope ofthis Affidavit <br />STATE OF INDIMA <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 acimowledged the execution of the foregoing Affidavit and Waiver of Lion. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the _! � day of <br />C 200 /,P , <br />Y J�", <br />Notary Publi ignature <br />My Commission Expires, <br />Residing, in cl (f County, Notary Publio Name <br />