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State of Indiana, County of <br />Final Waiver of Lien <br />being duly sworn thathe/she is the �rS, d+a + <br />(Title) <br />(Contractor) �� "- having contracted with � ne <br />of (Owner) <br />p t7 i S h i n S t1nl:L }�1 Qu1f ► n,I �-r re,GS 1+ 1 "+h i n t h e- <br />to furnish certain materials andlor labor as follows: (Description) <br />for a project known as _ .ALL(14t�y <br />to of Project) <br />located at _Lih'i <br />and owned by ...... l s i71"t,,A <br />and does hereby Ai Cher 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 aclatowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment tboreof by the <br />undersigned; <br />FINAL W that the final ba <br />lance due tfom the contractor is the suns of <br />K 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 of Lien which shall <br />become effective only upon receipt of such payment. <br />TIJEREFOIM, the undersigned waives and releases onto 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, fltrnisbad b the undersigned <br />thereto,, subject to hinitations or conditions expressed herein, if any; and f trther certifled that no other party has any claim or right to a <br />llen on account of any work performed; or material flrnilshed to the undersigned for said project, and wlthln the scope of this Affidavit <br />and Waiver ofLlem <br />. e— Er) .t� EY ) _�._...__ (Authorized It epresen Ytive) <br />STATE OF INDIANA ) <br />S5: <br />ST, JOSEPH COIJNTY } <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared 1--ou a <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. <br />IN WITNESS WHEREOF, I have hereunto subscribed myn name and affixed my official seal on the o? I St day of <br />Z <br />4N4Publi iguatur <br />My Commission Expires: "� ' [+_ L, <br />Residing in Tip {, county,�' _ <br />Z + NotaryPublio Name <br />JEENPIIFER L SCHULTZ <br />�(- W PUBLIC - OFFICIAL SEAL <br />Stagy.. md"sana, St. Joseph Count+� <br />nny Corn+n. P_xpires September 27,201 <br />