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Final Waiver of Lien <br />State oflndiana, County of <br />f+ ` S� J45- SS: <br />JO S�fr.1� ` /"` CLy rm/ being duly sworn that helshe is the K, <br />}L�(Name of Officer) /� r ( Title) <br />of /�IP��-/C i 045� (1d . I �7 C having contracted with �y c!J <br />(Contractor) (Owner) <br />to furnish certain materials andlor labor as follows: <br />(Description) <br />for a project known as �G-42l w 1�d 6 ey, i a/ar- -e l r4"hce to o c% Z(�/ &O'V-6 edO i' f A-�J 1 �v"' 6%CI <br />(N,ame ofprojeot) <br />located at CGL�I S iNJ GJ n O 4 f Lpa/ <br />and owned by Q z<_ _ &/Vid <br />(Owner) <br />and does hereby further state on the behalf of°the aforomentioned subcontractor/supplier; <br />(PARTIAL WAINSR) that there is due from the Contractor the sum of <br />Dollars <br />❑ moolpt of which is hereby aclotowledged; or <br />❑ the payment of which has boon promised as the sole consideration for this Affidavit and Final Waiver of Lien which 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 kom the contractor is the sum of - <br />�c) s ex v- aq v-e 8.� <br />fit <br />❑ receipt of'which is hereby aclatowledged; or u <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 />TBEREFORB, the undersigned waives and releases unto the owner of said premises, any and all lions or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, fiu'nished b the' undersigned <br />tirnroto, subject to limitations or conditions expressed herein, if any; and Aurther certified that no other party has any claim or right to a <br />lien on a000unt of any work pertbrfned or material furnished to the undersigned for saldproject, and within the scope ofthis Affidavit <br />and Waiver ofLlen. <br />i f l�r / n . y I <br />irm �.. a o o e Dr Mn,t�) S4le-s r% <br />STATE OF iNDIANA ) o s 1 <br />SS: <br />PH <br />NTY <br />ST. SOS Before me, undersigned, a Notary Public, in and for said County and State, personally appeared_ f ash r1 /r , ,/!'l ��O <br />YYYJ/C . <br />and aftowledged the execution of the foregoing Affidavit land Waiver of Lien. �" ' <br />r Y Y day of <br />IN WITNESS OF, I have hereunto subscribed m n e and affixed na official seal on the <br />zoo �� <br />Notary Public Signature <br />O / a i <br />My Commission Expires: % �a a- � <br />Residing in!JJust�phcounty, j a d i a nr-y (1 <br />Notary Public Name SUE ANNE C1RA <br />Seal <br />Notary Public • state of 14ani <br />St Joseph County ; <br />[MyCommieeion Eapirbe Oct 22, 2022 <br />