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Final Waiver of Lien <br />State of Indiana, County of % �SS: <br />(Name of Officer being duly sworn that he/she is the <br />of having contracted with City Of South Bend <br />(Contractor) (Owner) <br />to furnish certain, materials and/or labor as follows;?'IT�/"� (/'? <br />(Description) <br />for a project Imown as _ <br />(Name of Project) <br />located at <br />and owned by City of South Bend <br />(Owner) <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 />❑ recolpt of which is hereby acIntowledged; 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 amount, and which waiver sball be effective only upon receipt of payment thereof by the <br />undersigned,u° ^c� <br />(FINAL WAIVE II) that the final balance due from the contractor is the sum of <br />❑ receipt ofwhich is hereby acknowledged; or n g <br />® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which s <br />become effective only upon receipt of such payment. C <br />w�•=c" t. <br />THEREFORE, the utiderslgned waives and releases unto the Owner ofsa is a , any and all liens or claims whats m � � <br />on the above -described property and improvements thereon an account of labor " material ° both, furnished b the undersigned n , o M <br />thereto, subject to limitations or conditions expressed herein, if any; and firth ; certified the no other party has any claim or ri N o <br />Ron on account of any work performed or material tarnished to the undorsign for Bald pro" of within the scope of this Affa avl <br />and Waiver of Lien. <br />(Finn) <br />(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 acknowledged the execution of the foregoing Affidavit and Waiver of Lion. <br />_ y seal on the r/f day o€ <br />IN S WHEREOF, Ihave hereunto subsorlbed in name andaffixed m offtc aI <br />Notary Public ,gnature <br />y Expires: V( :' a x z "" <br />M Commission <br />Residing in l U " q County, .&O-Z-117441 <br />Notary Public Name <br />