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Final Waiver of Lien <br />State of Indiana, County of BA L101 SS; <br />G R E O l,J E being duly sworn that he/she is the <br />(Name of Officer) ('Title) <br />P4S�1C <br />of 11AE btM( having contracted with S ofzill Is( <br />(Contractor) (Owner) ' <br />to :i mish certain materials andlor labor as follows; <br />(Description) <br />% j- <br />for a project known as <br />located at <br />and owned by <br />and does hereby further state on the behalf of the aforementioned subcontractor/suppiler: <br />(PARTIAL WAIVER) that there is due from the Contractor the suns of <br />Dollars ($ ) <br />❑ receipt of which is hereby acknowledged; or <br />ip- <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver OfLienwh'ich 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 $om the contractor Is the sum of <br />❑ receipt of which is hereby acknowledged; or <br />dw�r"i.4 <br />XE E "II z 5 E' l~ mTE i" )A <br />t>0L WKS ANDEkGH-i-1-SI*CENTS <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 oulyuponreceipt 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 as account of labor or material or both, famished b the undersigned <br />thereto, subject to ]lmitatkous or conditions expressed herein, if any, and der certified that no other party has any claim or right to a <br />liars on accottnt ofany work performed or material t)xmishod to the undersigned for sald projects an lthin the scope of this Affidavit <br />and Waiver of Liam <br />By <br />") Gf� E G LID E theur ed Irreentativ), ES IACAIT <br />STATE OF INDIANA ) <br />SS: <br />ST, JOSEPH COUNTY ) � L <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared 7 OW E <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the E1 day of <br />a V ER�99 gt <br />No�Publico <br />MyCommission Expires:, <br />Residing MRWAESMACounty, RAI TOMNotary Public Namne <br />