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Final Waiver of Lien <br />State ofludlana, County of Elkhart SS: <br />iennifer Bur ess being duly sworn that he/she is the Corporate Secretary <br />(Name of Officer) (Title) <br />of C & E Excavating, Inc.. ._.w_ having contracted with Citv of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; �. al,o� & Materials <br />(Description) <br />for a project known as Ironwood Drive Pavement Rehabilitation and Intersection PN:117-071A <br />_ (Name of Project) <br />located at Ironwood and Edison, South Bend, IN <br />and owned by —LiSy—oL <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 />❑ 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 ofLlen 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 />Two hula Le hltt -semen thousartat four thousand s veoNt twro eollams and 60/100 r 7,472.60 <br />❑ receipt of which is hereby acknowledged; or <br />x❑ 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 lions or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both,, Aunished 'b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further eortitled that rno other party has any claim or right to a <br />Iien on account of any work performed or material furnished to the undersigned for said project, and wlthln the scope of this Affidavit <br />and Waiver of Lien. <br />C s� E Excavating, Inc. .. DY <br />(Firm) Au horiect Rrase tivo) <br />STATE OF INDIANA ) <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared JganifeLffi Vfqg5s <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS HER OF I have hereunto subscribed na01 la(. soap on the 2 a and affixed my of 0th day of <br />NovembeiA4"dJJW <br />Notary Pub <br />lic S re My Commission Expires: " p <br />Residing in 1 County, 1 VVAAM1VL0---1 <br />P�kaw6X$+nu ".WrnmFl rv.3'�.e <br />awwk'""""4idarro,n <br />r�'9�° <br />CRISTOL MELODY VAL.f71_. <br />Notary Public, State of Indiana, <br />Fr, <br />L <br />Elkhart County <br />Commission M 696906 <br />,, <br />My Commission Expires <br />February 20, 2025 <br />