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Final Waiver of Lien <br />State of Indiana, County of 'el— A SS: <br />being duly sworn that he/she is the �y P <br />(Name of Officer) (Title) <br />of t k ip w ` cllpwk" �l�aving contracted with to(Or U—t-H Bev <br />(Contractor) (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 />VL <br />M <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PAPTr4Y • INAivRR) that there is due from the Contractor the suns of <br />Dollars $ <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 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 />(Fl°l�"Al., WAl �/lll� that the final balanc due fCom the �otitractor is the sum of ,� <br />- � _ j�_ <br />❑ xeceipt of which is hereby aclrnowledged; trx <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 onlyuponreceipt 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 said project, and within the scope of this Affidavit <br />and Waiver ofLlen. <br />(Firm)� By <br />Uthor zed'lCepresentative) <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 .M&�& _Ak,�L <br />and acknowledged the execution of tho foregoing Affidavit and Waiver of Lion. 1i <br />F, I have hereunto subscribed my name and affixed my official seal on the day of T� <br />1N WITNESS WHEREOF, 200 1Q <br />N Public Signature <br />EE <br />Ivly �tarnissioia �p (J <br />Resi % in EAkoun , Notary Public Name <br />ATE <br />MY COMMISSION EXPIRES FEBRUARY 12, 20M <br />COMMISSION NO.710M <br />