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Final Waiver of Lien <br />State pfindiana, County of SS: <br />1� C91� being duly sworn that helshe is the <br />(Nance of Officer) (Title) <br />or i�.2M hs'Iag contracted with 71�9-0- j <br />(Contractor) Mwneri <br />to furnish cortaltr nmterlals and/or) <br />for a project known os <br />located at <br />and owned by <br />and sloes hereby further state on the behalf ofthe aforemmaoned subcontraotor/supplier; <br />(PARTIAL WAMR) that there is due from. the Cootractor the sum of <br />Dollars $ <br />❑ 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 oflliea-which is given <br />solely V th respect to said ain nut, and which waiver sbalt be, effective only upon receipt ofpayuaent thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the coruractor is the sum of <br />❑ recelpt ofwhich is hemby acknowledged; or <br />❑ thepayment of which has been promised as the sole consideration for this Aff"rdavlt and Final Waiver of Lien which snail <br />become effective only upon receipt of such payment. <br />TBEREFORE, the undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever <br />on the above-doscribedproperty and improvements theteon 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 further certified thatno other party has any claim, or right to a <br />lion on account of any work perfomod or material famished to the undorsigned for saldprojeet, and within the scope of this Affidavit <br />and Waiver of Lien. <br />(Firm) <br />(Authorized Reprsscntative} <br />STATE Olt lN7DIANA ) <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary public, In and for said Coiwty and State, personally appeared <br />and acknowledged tho execution of the foregoing Affidavit and Waiver of Lion. /�,� <br />IN WITNESS WI3EREQF, I have hereunto subscribed my namand affixed my official, seal on th r� / � day of <br />— I4j' 200 <br />. <br />/ / Signaturo �' <br />MyCommissloftRxpires,• 7 O <br />Residing fn 7' . n.0 ounfy, � I -�! J lotazyl'uhlia l`tarne <br />EMY <br />RYAN P.SOUSLEY <br />tary Public - State of Indiana <br />SEAL <br />ommission Number. 682754 <br />ommission Expires April 9, 2024 <br />