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Final Waiver of Lien <br />State of Indiana, County of Porter SS, <br />Frank A Marshall <br />being duty swomthat he/sheisthe President <br />(Name of Officer) (Title) <br />of G.E. Marshall, Inc _ having contracted with City of South Bend Dept of Public Works <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows: Storm. Sewer and Grading <br />(Description) <br />p Small ___..... _..._._ �,......._. a. g pair D ivA fora project as Draina a Design & Re ........___.._� . � ..., <br />(Name of Project) <br />located at Hawbaker Drive <br />and owned by <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 considerations for this Affidavit and Final Waiver of Lie,a 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 />One �adred) sevent balance due from the contractor is the sum of / mm <br />(FINAL WAIVER that the fines W 106.53 <br />n thousands'one hundred six 5 117, <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 premjs s, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or water' I or both, furnished b the tndersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certlfl #hatno other fear as int or right to a <br />lien on account of any work performed or material furnished to the undersigned for so' project, and wit a cope ftbis Affidavit <br />and Waiver of Lien. <br />G. E. Marshall Inc . BY .._.. _.:. <br />STATE 0.— .. ..._ <br />(F) (Authorised Repres ntative) <br />F INDIANA ) <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County' nd State, personaily appeared Frank A Marshall <br />and acknowledged the execution of the foregoing .affidavit and Waiver of Lien. <br />IN WITNESS WBEREOF, I have hereunto subscribed my name and affixed my off ial seat on the 12 day of <br />Aug , c 200 , <br />No ublic S fi aturo ,► tTl i' ii-1, <br />iMY r0;0 <br />° i <br />My Commission Expires, pires, � .�._.� � ���aa� ���W�� •�� ��^ <br />w" �. <br />Lorri 1�i1..ler�" , � a, <br />g County, IN Notary Pobli Naaiet tt�r« <br />Residing m Porter _ - <br />PUBLIC <br />NZ <br />'S/ON f0,)NI" <br />yyw, <br />tt� <br />