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Final Waiver of Lien <br />State of Indiana, County of SI., SS: / <br />o6 .e �C�k being duly sworn thaoshe is the �` e. <br />(acne of Officer) '� _ <br />(Titiel <br />oi�r' having contracted with <br />(Owner) <br />to furnish certain materials and/or labor as follows;41 „��✓ ..... <br />(Description) <br />for a project known as -� .L C} �'j ��•� �.�.3}� <br />(Name of Projeot) - <br />1 /y <br />located at N <br />and owned by '0 f 6 <br />-- �.. <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 Jt <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 of Lien 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 />F )40 6 of ly WR t the IWa 54rLedue m t e to the . _ .m� <br />�� a .. , Ga? 6e_:;f3 <br />❑ receipt ofwhl' h is I�vby 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 />THEREFORE, the undersigned 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 herein, if any; and further 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 said project, and within the scope of this Affidavit jl <br />and Waiver of Lien.Ilk <br />~" <br />_ /'I CBy=" <br />STATE OF IMIANA ) Ss f3 y <br />k <br />ST. JOSEPH COUNTY } <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared��--�/ <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />iN 1T1�11» S WHEREOF, I have hereunto subscribed my name and affixed my official seal on the d day of <br />t <br />Notary Publl Sf,gnattra nmm� <br />My Commission Expires: ' 1P 0) <br />Residing in . Jd County, %L C!• <br />at:nCrm <br />SUE ANNE CI11A <br />Seal <br />Notary Public • State of Indiana <br />St Joseph County <br />Commission Expires Oct 22, 2022 <br />