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AFFIDAVIT AND WAIVER OF LIEN <br />State of Indiana, County of St- Joseph SS: <br />Larry --- Cripe being duly sworn that he/she is the Power —of —Attorney <br />_ _ <br />(Name of Officer) _._ .. (Title) <br />of Herrman & G- et.z_,_ Inca having contracted with _ <br />Subcontractor/Su her �'--'�•••-���n�th„Ben <br />( pp ) (Contractor) <br />to furnish certain materials and/or labor as follows:-1eelaar1-al work — <br />for <br />and owned by uQi of South Bend <br />_W.............__ — <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 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 />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />Forty seven thousand two hundred eighty—seven Dollars $47( ,2B7.0 <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 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 parry 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 <br />and Waiver of Lien. <br />Ile <br />Herrman & Goetz, Inc <br />STATE OF... _........ ( .) _ ). (.. m.... _.. <br />Fug �� ....� ..��.... Au rb�ed Representative).. <br />1NDIANA <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Larry Crip � _„ ,„ <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the _I_& day of <br />May MX2019 <br />211 <br />Notary 1, i hc, Sogl tore <br />My Commission Expires: 7 / 13 / 2022...... <br />Catherine J. Gruber <br />g Jose _h County, ln.diaraa.... _.....__ NotPublic <br />Residing in St . P Notary Name <br />