Laserfiche WebLink
b, C <br />State of Indiana, County of SS: <br />Kauit 'being duly sworn that he/she is the 66(o <br />'M Lt(?— — <br />(Name of Officer) (Title) <br />of IpV V, RAVC' '!;//,)U 5 il5 having contracted with <br />(Subcontractor/Supplier) <br />to furnish certain materials and/or labor as follows: <br />(Contractor) <br />for a project known as eAA /-6 � 9T'5 C00W /14AWyM �i5FLAJ /�Ot 464& <br />(Name of Project) <br />located at N, 1414164Aj -e :50ttM -9 o/4>. VJ 6 60 It <br />and owned by 5`0 U III <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is, due from the Contractor the sum of <br />Dollars ($ <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 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 from the contractor is the sum of <br />($ Mlsz 0 C? ) <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 both, furnished b the undersigned <br />thereto, subject It imitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />*t lien on accou any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit <br />and ive ien. <br />1 <br />.6 <br />By <br />6L_o1-kA1,4,,te1 *F4n:a)_ :A&O, -(*uthorized-Rqresentafivft <br />STATE OF INDIANA <br />ST. JOSEPH COUNTY <br />Before me, the <br />and acknowledged the e <br />IN WITNESS I <br />Faso �13 <br />SEAL - <br />080 <br />OF 'I 14P. <br />Residing in .Q� County, <br />0 1 <br />and for said County and State, personally appeared <br />jt and Waiver of Lien, <br />z <br />;qribed my name and affixed my official seat on the day of <br />200 <br />Notary Public Sign <br />RUM. <br />k J <br />orina-7-1 ma,le—ner <br />Notary Public Name <br />