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AFFIDAVIT AND WAIVER OF LIEN <br />State of Indiana, County of ` SS: <br />being duly sworn that he/she is the <br />(Name of Officer) <br />of � ... '� M a+ �'." ,W having contracted with D <br />(Sub ntractor�4u Gier _ .. <br />pp ) (Contractor) <br />�j�—i ,2 to furnish certain materials and/or labor as follows: �'��h`�C�" ` ���'!�% vGmS...� <br />(Description) <br />for a project known as..lYl `a�r✓/� �� �...... <br />(Name ofProject) <br />located at ,( <br />and owned by <br />(Owner) SUE ANNE MIA <br />Sul <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: I Nohry Public - State of Indiana <br />St Joseph County <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of My ConWaslon Eaptres Oct 22, 2022 <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 />(IfNAL WAIVER) that the final . a .a� nce due _ ton ��ttra .... is theum of ...._...�� .v <br />4-.. <br />❑ receipt of which is here Ky ac o ledged,; 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 />STATE OF INDIANA <br />SS. <br />ST• JOSEPH COUNTY ) L <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally apeare�7 ��/CJ� <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />INWITNESS HEREOF, I have hereunto subscribed nay name and affixed my official seal on the � � day of <br />�0..... . <br />NotPublic <br />ary Public Signature <br />My Commission Expires: e� a <br />Residing in County, ty, m ..... Notary 4 mm N ry Public Name <br />