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Final Waiver of Lien <br />State ofindiana, County of 4 �i SS: <br />being duly sworn that helshe is the�� <br />nine o£Of cer, (11 le) <br />Of I i si "ice mm` leaving contracted with <br />(Contractor) �(Qwner) <br />to furnish certain materials andlor labor as follows: <br />,�r <br />for a project known as -C) rGl i` (+t` (` fit st'd ,�" �( VIA f U" <br />(lame ofProjeot) <br />located at �rr a s ^ _ 1, <br />and owned by <br />(Owner) <br />and does hereby fanther state on the behalfofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars �........ . . <br />Q receipt of which is hereby acknowledged; or <br />© the payn°aent Of Which has been promised as tho ,sole consideration for this Affidavit said Final Waiver ofLien-vhlch is given <br />solely with respect to said amount, aricl which waiver" shall be cZoctivo only upon rea elpt of paynlent thereof by file <br />undersigned; <br />WAI'l3.I0 that thr <br />1 oma of <br />e final blalmce clue ffo n cor,dractor isthe st <br />r <br />© xeceipt of which is hereby aclrnowiedged; or <br />]� the payarient Of wbiclrs has been promised as the sole consideration for this Affidavit and Final Walver° of Lien which shall <br />become eli"ective only upon rccelpt of such payment. <br />THEREFORE, the undersigned waives and releases unto the CJwner° ofsaid premises, any and all liens or claims whatsoever <br />oil the, above-describedproperty and improvements thereon an, accoarut of labor or material or both, furnished b the undersigned <br />tharcto, subject to lianitatlons or conditions expressed herein,, if any, and Iiartlrcr cersifled thatno other party has any claim orri htto a <br />acid Waiver ol'Iofa y p undersigned for said projcct, and wlthlxl the sc pa of this Affidavit <br />iacn on account of any, work performed or material tlrrriisli�d, to the rurdei�l . <br />12 <br />TAT E DP IDIA&ti y _... ( t p <br />M <br />on e Re resell (atnv+) <br />SS: <br />E-0)l bhj m ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared„.', (.w, <br />and acknowledged the execution of the foregoing Affidavit and Waiver afLion. <br />i Ihavehereunto subscribed name y �� a �./ <br />_,� ... day of <br />200, � WITNESS �ERL''DI.a grad affixed m official seal on the <br />my Commission Expires: ' - ' <br />Residing in <br />Signature <br />JANEE M <br />I€i7a4ttV <br />`"`"".�' T-INDIANA VotaryPublic Name <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION NO.710399 <br />