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Final Waiver of Lien <br />State of Indiana, County of SS: <br />being duly sworn that he/she is the <br />(Name of Officer), (Title) <br />of having contracted with <br />(O'ontractor _ (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 />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 consideration fhr 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 balance due from the contractor is the sum of <br />❑ receipt of which is hereby acknowledged; or <br />ICJ the payment of which lies been, promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only upon reoeipt 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 />lien on account of any work performed or material furnished to the undersigned for saltl;proe6t,nd within the scope of this Affiidavlt. <br />an Waiver of Lien. <br />/'L'e' By <br />l`h°tt (Authorized Representative) <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 aclatowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have horounto subscribed my name and affixed my official seal on the 45441- day of <br />200 <br />O` ' OTA 9 <br />Not Public Si iu°o <br />My Commission Expires: ► t Y*'Y Comm. Expires <br />Z : Janu4tY a, 202e ^ " <br />Residing in county, - w "SEAL ` tart' Public Name <br />f''"� OF-it~tO.''"w <br />