Laserfiche WebLink
Final Waiver of Lien <br />St to oflnal#ariii, County of � mm S <br />being duly sworn that he/she is the <br />(Name of cer)J) <br />(title) <br />of having contracted with <br />(Contractor) (Owner) <br />RO <br />to famish certain materials and/or labor as follows: 10 <br />, � � (Description) <br />for a project known as <br />of IPrMP.AA <br />located at <br />and owned by <br />and does hereby farther 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 aclazowledged; 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 sball be effective only upon receipt of payment thereof by the <br />undersigned; <br />MAL WAIV that the fia a1 alanc due M t contra , or i e sum of <br />❑ receipt of which is hereby aftowledged, or <br />the payment of which has been promised as the sole consideration for ibis 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 ofsaid 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 famished to the undersigned for said project, and within the scope of this Affidavit <br />d Waiver of Lien. <br />14 <br />a <br />(F' } INA <br />By ( th a epres ve <br />nm } <br />STATE OF INDIANA ) <br />SS: <br />ST. JOSEPH COUNTY } <br />Before me, the undersigned, a Notary Public, in and for said Co"t YOMAMWo nonally appeared 40 <br />and aclmowledged the execution of the foregoing Affidavit and Walvo.° %zt- <br />My WI E,SS REOF, I have hereunto subscribed my nil aMXe"l`ns n the da of <br />200 ,SEAPub cSlgnatComnissionExpires; <br />Residing in County, Jlad\t/--� 'l 111 r i i P 11 d 1 b° otatry Prtb o Name <br />x ' <br />