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Final Waiver of Lien <br />State oflndiana, County of St.. Joseph SS: <br />Dustin Hilary being duly sworn that he/she is the South Bend Area Vice President <br />(Name of Officer) (Title) <br />of Walsh & Kelly, Inc. having contracted with City of South Bend, Indiana <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; <br />for a project known as <br />located at <br />and owned by <br />Civic Al <br />It Paving and Concrete Work <br />Repaving <br />Main Street Area, South Bend, IN <br />of South Bend, Indiana <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 suns of <br />Dollars <br />❑ receipt of which is hereby acknowledged; or <br />❑ the payment of which lies been promised as the sole consideration for this Affidavit and final Waiver of Lien: which is given <br />solely with respect to said asnowit, and which waiver sball 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 3, 3 17.38 <br />❑ receipt of which is hereby acknowledged; or <br />® the payment ofwhich has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become offective on(y 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, famished b the undersigned <br />thereto, subject to limitations or conditions expressed l s and further certified that fro r party has any claim or right to a <br />lien on account of any work performed or material s dui ersigned for said project we scope of this Affidavit <br />and Waiver of Lion. <br />y / <br />Walsh & Kelly, Inc: GO qq <br />r Apre entail <br />'ft <br />'rn) ft oe <br />STATE of INDIANA ) SEAL*; n Hilary, (South Bend rea1Pce President <br />SS: <br />ST. JOSEPH COUNTY )''• .•°w"" <br />unty and State, personally appeared Dustin Hilary <br />Before me, the undersigned, a Notary Pubir`# QAA <br />and acknowledged the execution of the foregoing Aff SPIO'MV alver omen. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my otficlal al on the 24th day of <br />200 19 . <br />l <br />N t� Publi Signature <br />My Commission Expires: June 7, 2023 <br />Residingin Marshall h Turpin <br />County, Indiana 0 � Elizabeth �. <br />Y 400ETH TUf PIN <br />Notary dub ie State of Indians <br />Marshall County <br />Commission 6xpirQ6 <br />June 7, 2024 <br />