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Final Waiver of Lien <br />State of Mana, County of St. Joseph <br />SS* <br />-Dustin Hilary being duly swom that he/she is the. South Bend Area Vice President <br />(Name of Officer) (IYtie) <br />of Walsh & Kelly, Inc. <br />having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain, materials andlor labor as follows: —,— Asphalt, Concrete and Pavement Marking <br />(Description) <br />for a project Imown as # 117-033A: Ironwood Drive Sidewalk, Edison Road to State Road 23 <br />(Name, ofilrojeot) <br />located at Ironwood Drive, Edison Road to State Road 23 <br />and owned by City of South Bend <br />(Owner) <br />and does hereby fluther state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the Sam of <br />Dollars <br />.-($-- - L­­�_� <br />0 receipt of which is hereby acknowledged; or <br />El the Payment of which has been promised as the sole consideration for this Affidavit and Mal Waiver offion which is given <br />Solely willi respect to said anionnt, and which 1volver shpil be cirertive only upon receipt orpsyraejIt thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the am of <br />[I receipt ofthich is hereby admouiedged; or <br />21 the Payment of which has been promised as the solo consideration for this Affidavit and Final Waiver of Lien which Shall <br />become effective only upon receipt ofsuch payntont, <br />THEREFORE, the undersigned waives and releases unto the Ownor of said promises, any and all liens or claims whatsoever <br />on the above-describedpropexty and improventents thereon: anaccount of labor orma(arlat A thfbmishe-0the undersigned <br />thavelo, subject to limitations or conditions oxprossed1wr �Pl;and "bcrcerfife at o o6er has [lily claim or right to a <br />lien oil a0collat of any work perfomed ormatodal e�, ( 17d4oarsignedfor 1) OA an n tho scope ofibis Affidavit <br />and Walver of Lien. po <br />I Ole <br />Walsh& Kelly, ()RAT <br />Inc. Z' <br />(Firm) _J00 9, <br />0 thorized Replescntat vo) <br />STATE OF INMANA g <br />SS: <br />STI JOSEPH COUNTY Z' <br />N Dustin Hilary <br />x M <br />Before me, the undersigned, a Notary pil on and Slate personally appeared <br />and acknowledged the execution Of 1:110 forr,801119 A Abil r Or of Lien. <br />IN WITNESS *P,hod my name and affixed my Officseal on the 5th day of <br />November 200 18 <br />WiOP�ubllc Signature <br />MyCommissinnExpires, June 07, 2023 <br />Residingin ndiana county, Marshall <br />Amy Elizabeth Turpin <br />No, u 11' <br />RPIN <br />