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Final Waiver of Lien <br />State of Indiana, County of , os Ss <br />(Name...�.�.,,..„,,��� being duly sworn that he/she is the <br />Officer) <br />(Title). <br />of �+ . <br />having contracted with "44 . ,. <br />(Contractor) <br />(Owner) <br />to famish certain materials and/or labor as follows; �I "1U t . - <br />(Description) <br />for a project known as <br />(lwlaane ofrojootj-�,�,-..� <br />-W located at <br />and owned by i►��i , e �e s L L e <br />(Owner) <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier.- <br />(PARTIAL WAVER) that there is due from the Contractor the sum of <br />Dollars , <br />❑ receipt of which is hereby acknowledged; or <br />❑ rite payment of which has been promised as the sole consideration fbr this Affidavit anti Final Waiver ofUenwhich is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of paayment thereof by the <br />uaadersigned; <br />v the stern, of <br />ll'I�IAL WAl"�lllt th t .� e final balance due f era the con is <br />receipt of which is hereby acknowledged; or <br />❑ the payment of w}rich bas been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effeotive only upon receipt of such payment. <br />TIEWOft,E, the underaigned waives and releases unto the Ovaaier ofsald promises, any and all liens or claims whatsoever <br />on the above -described property and im1wovemeawts thereon au accctuwt of labor or trmterial or both, fbrnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any, and fi rther certiflod that no other party has any claim or right o a <br />t <br />Ilea on acconaat of any wont performed or rawaterlaI i?umishe to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver ofL,lea <br />(Firm)By <br />cif <br />STATE OF'INDIANA A(Awx rI ed Itepresc�aa live) <br />ST. IOSEm CO NI*y. <br />SS;: <br />Refore me the undersigiwed, a Notary Public, In and for said County and State, personally appeared <br />and acknowledged, the execution oftlao foregoing Affidavit and. Waiver of Lion, <br />Ilwl WITN ESS WBE-REOF, I have haarounto subscribed my name and afli'xed <br />200 <br />My Commission Expires-,, <br />Real� " , <br />d o E County, <br />�ota <br />State of Indlana <br />�. St Joseph County <br />twty Commission Expires Apr 15, 2023 <br />