Laserfiche WebLink
Final Waiver of Lien <br />State of Indiana, County of SS: <br />" being duly sworn that he/she is the <br />"er)ane0fC <br />ofhaving contracted with <br />Contractor) <br />(Owner) <br />to furnish certain materials and/or labor as follows; " L <br />(Description) <br />for a project known as L_ _."�• g'�ya, <br />(Name €1�rojoot} <br />located at <br />and owned by <br />(Ovvater} <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 />Cho payment of which has been promised its the sole consideration for this Affidavit aatd Final Waiver of"Lleaa 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 />1 <br />(FINAL WAIVER) that the fins � —1 balance due from the contractor is the <br />sum of <br />1 5 <br />❑ receipt of which is hereby acknowledged; or <br />the paymeut of Which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become affective only Capon receipt of such payment. <br />1" 1BREFORE, the undersigned waives and releases uinto the Owner ofsaid premises, any and all liens or claims whatsoever <br />oil the above -described property and improvements thereon tut rtcco'uut of labor or material or 'both, Runishell b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; said 11wilyer certified that no other panty has tiny claim or right to a <br />lien on accoaant of any work performed or material furnished to tine undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lien. <br />_ ` (Firm) <br />t w BY ._ _ sized sent i <br />uxn ttva m . <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 <br />and aclatowlcdged the execution oftltc foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WRL �0r, I have hereuntohereuntosubscril oaQy na� me and axed yyi seal on the day of <br />,..., .t Publto.Signa . <br />My Commission Expires: <br />� • _. yr ^ � Notary Public akm e <br />Residing in A x i Mount A <br />E <br />HLAN MACKENNA SMITH <br />Seal <br />ary Public - State of Indiana <br />St Joseph County <br />mmission Expires May 20, 2025 <br />