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AFFIDAVIT AND WAIVER OF LIEN <br />FINAL PARTIAL PAYMENT TO FOLLOW <br />a <br />State Of Indiana, County of St. lose h SS:. <br />Gerald' Lon erot being duly sworn states that he is the President of <br />Slatile Roofing & Sheet Metal Co. Inc, <br />(Subcontractor/Supplier) (Contractor) <br />Furnish certain materials and/or labor as follows: jt' <br />For a project known as n In I n 1 4? <br />located at; and owed by <br />(Owner) <br />and does hereby further state on behalf of the aforementioned subonctractors/supplier:, <br />PARTIAL Waiver that is due from the contractor the sum of: <br />0 Receipt of which is hereby acknowledged: or <br />Ilars(_ <br />OThe payment of which has been promised as the sole considertion ofthis Affidavit and Partial <br />Waiver of Lien which is given solely with respect to said amount, and which waiver shall be <br />affective only upon receipt of payment thereof by the undersigned: <br />(FINAL WAIVER) that the final balance due from the contractor is the s 1 of Q (� <br />DOA 11�1 Dollars <br />Receipt of which is hereby acknowledged; or <br />0The payment of which has been promised as the sole consideration for this Affidavit and <br />Fin I Waiver of Lien which shall become effective upon receipt of such paymenat. <br />THEREFORE, The undersigned wiaves the releases unto the Owner of the said premises, any and all <br />lein or claim whatsoever on the above -described property and improved ments thereon on account <br />of LABOR or matieral or both, furnished by the undersigned thereto, subject or conditions expressed <br />herein, if any: and further certifies that no other party has a claim or right to lien on account of any work <br />performed or material furnished to the underisgned for siad pri aid project, and within the scope of this affidavi <br />and waiver. <br />,Slatile RoofinR & Sheet Metal Co. Inc. By c aCAAR <br />(Firm) (Authorized Repres <br />WITNESS MY HAND AND D NOTARY SEAL, this <br />My commission Expires: 09 01 21 <br />President <br />CNN <br />bylof <br />M.SI 'M <br />I / ) r �R �V G d n W4iI <br />Printed: Lou Ann Ward <br />Residing in Elkhart County <br />