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Final Waiver of Lien <br />State of Indiana, County of 2k SS: <br />being duly sworn that he/she is the <br />(Nacre of Officer) (Title) <br />of 4 :.. having contracted with <br />(Contractor) e IT (Owner) <br />to furnish certain materials andlor labor as follows; <br />for a project known as <br />located at <br />and owned by <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 aclmowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver ofLienwhich 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 />W 1 Milt) t the final balance Ae from the contr" otor is the tau of 10.0 <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 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 party has any claim or right to a <br />Peen on account of any work performed or material famished to the undersigned for said project, and within the scope of this Affidavit <br />M <br />iverofLl n.IA BY <br />.w <br />(Finn) (Authorized Representative) <br />STATE OF iNDlANA <br />SS: � `(�1 <br />ST. JOSEPH COUNTY <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared _&Uajk)� <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />1"rNESS WM EOF, I have hereunto subscribed my narne and affixed my official seal on the q\C1 day of <br />LA 200 <br />f _ NoEy public Signature <br />My ottuxaission , fires; ' <br />Residing in ACounty, " <br />Viii it 6, <br />% Not F'ub0c, StWO of Rndlans <br />ST, J'CSiNIH COUNTY <br />SEAL Commission Number 705831 <br />�`M c ofornusskm Expires <br />