Laserfiche WebLink
Final Waiver of Lien <br />State oflndiana, County of �� V O SS: <br />J O" n, -Fe.^ being duly sworn that he/she is the A-c b5 ' h <br />(Nam off Officer) �,� j1 (Title) <br />Of �� to kng contracted wiHr C l l� ok S,ik lie <br />(Contractor) (Owner) <br />to fiunish certain materials and/or labor as follows: A'Lz, C1 Z'7 t'. I <br />(Description) <br />for a project known as <br />(Name of Project) <br />located at <br />and owned by <br />(owner) <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTIAL, WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />❑ receipt of which is hereby aclaxowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lienwhich is given <br />solely with respect to said amount and which waiver shall be efiective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL. WAIVED that the final balance due from the contractor is the sum of J J <br />., <br />❑ receipt of which is hereby acknowledged; or <br />'f ` the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective on(y upon receipt of such pagyment.. <br />TIMMORE, the underalgined 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 to limitations or conditions expressed herain, if any; and fin their certified that no other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for acid project; and within the scope ofthis Affidavit <br />and Waiver ofI.Aen. <br />16l <br />(Firm.) t 71od eps�ascntativq) <br />STATE OF INDIANA ) <br />SS: <br />ST. JOS13PH COUNTY } <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared " <br />and admowledged the execution of the foregoing Affidavit and Waiver ofLien. <br />IN WITNESS" WHEREOF, I have hereunto subscribed my name and affixed my official seal on the - 17 � day of <br />'' 200 <br />1+1 Publlta graatauo <br />My Commission Expires: ZA2 1We HW <br />g • �.Y Y� 6 F��u N Ai w0.i� Resldin m T County, �. l+la py <br />My Commission Expires <br />February 02, 2020 <br />