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AFFIDAVIT AND WAIVER OF LIEN <br />State of Indiana, County of d �Q(fG SS: <br />�..._.. . _..... _ -. �.._ w. ...._ .. <br />being duly sworn that he/she is the <br />(Name of Officer) (Title) <br />of 14rf� % .. �I .,., �� .._,.. having contracted with ,Ile s% Q <br />(Subcontractor/Supplier) Contractor <br />to furnish certain materials and/or labor as follows:------------- <br />(I)escription) _ <br />for a project known as �...,f _.__ ; qr!.r.U.......... <br />(Name of Project) <br />located at <br />and owned by <br />(Owner)+■r.»,r�. <br />LINDA J GILROY <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier; �v "m�, Notary Public, State of Indiana <br />r St, Joseph County <br />+ w` Commission Number NP0721620 <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of .,,' DP,***t w. My Commission Expires <br />°"�40 110 July 31, 2027 <br />Dollars ($ <br />............. ,. ...... ... _............ --------- <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 cc due from the contractor is the sum of 1i�, 1 <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 />l become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner rforsaid <br />miscs, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labia or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and ftlrl.'1ti t no other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigtl1 ajc C and within the scope of this Affidavit <br />and Waiver of Lien.,, <br />By <br />(Firm). p . <br />esc-rltative) <br />STATE OF INDIANA ) <br />SS: <br />ST, JOSEPH COUNTY <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared (f <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my na "ie sand affixed my official seal on the T day of <br />_ A.__.lrn� ... .. ....._. <br />tary Pull intture <br />My Commission Expires: <br />_..._A_ <br />.�� .. . ...._1,�,eoy <br />Residing in f rr (f Dc�County, otary Public Name <br />